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Study Revives Debate on Prostate Drug
Date:3/31/2010

used to detect cancers. Most of the cancers that were detected were not the aggressive form that causes major disorganization of the prostate gland. Less aggressive cancers often can be left untreated because they grow so slowly as to be no threat to life.

Andriole said that Avodart is beneficial because it reduces the number of such cancers detected by biopsy. "If we can eliminate diagnosis of these trivial cancers, we can save a lot of worry," he said. "These cancers tend to be treated because there is a lot of anxiety about them. If we can eliminate some of them, there is a huge benefit in public health terms."

Because of this, Andriole said, he would consider prescribing Avodart for cancer prevention to a man at high risk because of high PSA levels or family history, though the drug is not approved for that purpose by the U.S. Food and Drug Administration.

That's not good, said Dr. Patrick C. Walsh, a professor of urology at Johns Hopkins Medical Institutions, who wrote the accompanying editorial.

"When you look at the results, they are very similar to those of the finasteride study," Walsh said. "Dutasteride reduces by 23 percent the incidence of non-lethal cancers that men never knew they had."

The cancers detected in the study were found by biopsies that would ordinarily not be done because there were no indications of risk. Biopsies done in the study on men known to be at higher risk because of PSA levels found no difference in cancer incidence between those taking the drug and those taking the placebo, Walsh said.

And there is potential danger for men who take the drug, he said, because Avodart lowers the blood levels of PSA so that a warning increase might go unnoticed. "If their PSA level goes up, the chance of having a potentially lethal form of cancer is sixfold higher," he said.

Men who look for guidance on the issue shouldn't expect help from specialist societies. Guidelines issued
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