Healthy men older than 55 who are concerned enough about the risk of prostate cancer to undergo annual PSA screening should consider taking the drug finasteride daily to reduce their risk of developing the disease, according to a new prevention guideline released Tuesday.
“If a man is interested enough in being screened, then at least he ought to have the benefits of a discussion (with his doctor about taking the drug),” Dr. Barnett Kramer of the National Institutes of Health said at a news conference announcing the guideline.
Kramer co-chaired the panel that developed the recommendation for the American Society of Clinical Oncology and the American Urological Association. It will be published in the March issues of the Journal of Clinical Oncology and the Journal of Urology.
The most likely initial candidates to take the drug would be blacks and men with a father or brother with the disease, both of which sharply increase risk, said Dr. Jack Jacoub, a medical oncologist at Orange Coast Memorial Hospital in Fountain Valley, Calif., who was not a member of the panel. Many physicians have been prescribing it for their highest-risk patients, he said.
The recommendation targets men with a normal reading on the prostate-specific-antigen or PSA test, which is considered the best indicator of the presence of a tumor, because clinical trials of the drug covered only such men. The panel stopped short of recommending that all men take the drug because clinical trials have not shown it reduces deaths.
Prostate cancer is the second-leading cause of cancer deaths among men, behind lung cancer, with 186,000 cases diagnosed each year and 28,660 deaths.
Finasteride is used in low doses under the brand name Propecia as an anti-balding drug and in higher doses under the name Proscar for shrinking enlarged prostate glands. The dose recommended for cancer prevention is the same dosage used in Proscar. The drug interferes with the production of male hormones, starving the tumors of fuel they need to grow.
