Men, here’s what you need to know before taking a drug to prevent prostate cancer

Second Opinion

Men, if your doctor recommends a drug called Avodart to help lower your risk of prostate cancer, he’s going to offer some evidence that might seem convincing.

But let’s not rush into anything.

Avodart is designed to treat enlarged prostate (also known as BPH, or benign prostatic hyperplasia). In a recent New England Journal of Medicine study, about 3,300 men at high risk of prostate cancer took Avodart for four years. About 3,420 men–also at high risk–took a placebo.

Compared to placebo, the relative risk of any level of prostate cancer was reduced by nearly 23 percent in the Avodart group.

So based purely on that number, your doctor might encourage you to take Avodart if you’re at high risk of prostate cancer. And keep in mind that every man between the ages of 50 and 75 is considered high risk.

But let’s look a little deeper before you fill that prescription…

• In years one through four, nearly all subjects underwent a needle biopsy
• Among 3,299 men in the Avodart group, 220 tumors were detected with moderate to high Gleason scores (the system that rates the aggressiveness of tumors)
• Among 3,407 men in the placebo group, 233 tumors were detected with moderate to high Gleason scores
• During years three and four, 12 tumors with high Gleason scores were discovered in the Avodart group, but only one in the placebo group

So when it comes to aggressive tumors, Avodart doesn’t appear to reduce risk at all.

And then there were the side effects: Sexual dysfunction was significantly higher in the Avodart group, and–even more important to know–subjects in that group were nearly twice as likely to experience heart failure compared to placebo.

The doctor will see you now…

At this point, any man who’s still on the fence about using this expensive drug to prevent prostate cancer should consider a second opinion from an experienced urologist. Someone like Patrick Walsh, M.D.

Dr. Walsh is currently a Distinguished Service Professor of Urology at Baltimore’s Johns Hopkins School of Medicine where he served as Urologist-in-Chief for 30 years. In other words, when it comes to man-plumbing, Dr. Walsh knows his stuff.

An editorial by Dr. Walsh appears in the same NEJM issue as the Avodart study. And to get the full gist, you’ll need to know that “dutasteride” is the generic name for Avodart, and “finasteride” is the generic name for Proscar, another popular BPH drug.

Dr. Walsh: “Dutasteride and finasteride do not prevent prostate cancer but merely temporarily shrink tumors that have a low potential for being lethal, and they do not reduce the risk of a positive biopsy in patients who have an elevated PSA level.”

And just last year, in the journal Prostate Cancer Discovery, Dr. Walsh had this to say about finasteride: “Men will believe that it prevents cancer, will be pleased that their PSA levels fall, and will not understand the potential danger they’re in–of undiagnosed high-grade disease.”

In a recent interview with Medscape Oncology, Dr. Walsh said his 2009 comments about finasteride also apply to dutasteride.

Speaking specifically about the Avodart study, he said the results showed, “there was a 23% reduction in low-grade tumors that the patients would never have known they had. Does this sound like an indication to take a pill with sexual side effects that costs $4 a day?”

If Dr. Walsh is unimpressed with the Avodart study results, there’s no reason you or your doctor should be impressed.

To Your Good Health,

Jenny Thompson

Sources:
“Effect of Dutasteride on the Risk of Prostate Cancer” New England Journal of Medicine, Vol. 362, No. 13, 4/1/10, content.nejm.org
“Dutasteride Results Reignite Debate about Prevention of Prostate Cancer” Zosia Chustecka, Medscape, 3/31/10, medscape.com
“Finasteride: Are the Risks Worth it?” Prostate Cancer Discovery, Vol. 5, Winter 2009, urology.jhu.edu