Doctors Back Wider Consideration of Prostate Drug

By: By MARILYNN MARCHIONE
By: By MARILYNN MARCHIONE

For the first time, leading medical groups are advising millions
of healthy men who are regularly screened for prostate cancer to
consider taking a drug to prevent the disease.

The advice stops short of saying men should take the drug
finasteride, sold in generic form and as Proscar. It is already
widely used for urinary problems from enlarged prostates as men
age.

However, it has not been widely prescribed as a cancer
preventive, and it may carry some risks. The new guidance tells men
to talk to their doctors and decide for themselves if the good
outweighs the bad.

This advice is bound to be confusing, doctors admit. For one
thing, it doesn't apply to men who choose not to have screening
with PSA blood tests, which no major medical groups recommend.

In men who are regularly screened, finasteride can cut the odds
of being diagnosed with prostate cancer by about 25 percent.

"If a man is interested enough in being screened, then at least
he ought to have the benefits of a discussion" about taking the
drug, said Dr. Barnett Kramer, a National Institutes of Health
scientist and one of the authors of the new guidelines.

They were published in two medical journals and discussed in a
news briefing Tuesday in connection with a cancer conference in
Florida. They were written by doctors with American Society of
Clinical Oncology and the American Urological Association.

Cost could be a big issue for many men. Finasteride, which must
be taken daily, costs $2 to $3 a pill and insurers may not cover it
for cancer prevention. Also, to prevent a single additional case of
cancer, 71 men would have to take the drug for seven years -
another reason this is an individual decision, doctors say.

"There probably would be millions of different attitudes about
taking a pill a day to prevent a condition that may or may not
occur," said Dr. Howard Sandler, of Cedars-Sinai Medical Center in
Los Angeles.

About 186,000 American men this year will be told they have
cancer of the prostate. The disease often is diagnosed from a
biopsy after a suspicious PSA blood test, which measures a protein.
PSA can be high for many reasons, and there's no proof that
screening saves lives - the reason no major cancer groups recommend
it.

Most men over 55 get the test anyway, then face a dilemma if
cancer is found. It usually grows so slowly it is not
life-threatening, but it can prove fatal. Treatments often cause
sexual or bladder control problems.

"We still don't know if screening and aggressive treatment is a
good thing," but if men are getting PSA tests, taking finasteride
is reasonable, said the American Cancer Society's chief medical
officer, Dr. Otis Brawley.

Finasteride shrinks the prostate and curbs testosterone, a
hormone that helps cancer grow. It's already used for urinary
problems, and at a lower dose, it's sold as the baldness drug
Propecia.

A similar drug, dutasteride, sold as Avodart, is being tested to
see if it, too, prevents prostate cancer. The guideline covers the
whole class of drugs but for now, doctors are focused on
finasteride.

That's because it's the only one shown to prevent cancer so far.
A landmark study in 2003 found fewer men who took it got prostate
cancer than those on dummy pills. However, that study also raised a
concern: Those on the drug who did get cancer seemed to have more
aggressive tumors.

More study found that that wasn't the case. It was just that the
tumors were more easy to detect among men taking the drug because
it helped reduce prostate size.

The new advice to consider finasteride "is long overdue," said
Dr. Eric Klein, prostate cancer chief at the Cleveland Clinic. When
men are given a full picture of the drug's effects, "it's not a
tough sell," he said.

Finasteride has been linked to lower sexual desire and
difficulty having an erection. However, in a study of older men,
those were problems for most who weren't taking the drug as well.
Finasteride also gave benefits: fewer urinary problems and less
incontinence.

"The overall quality of life was identical," and most side
effects go away after a few weeks of use, Kramer said.

Three of the 15 guideline writers have consulted for Merck &
Co., which makes Proscar, or GlaxoSmithKline PLC, which makes
Avodart.

The advice is "aimed at people like me 10 years ago," said
Stewart Justman, a 60-year-old literature professor at University
of Montana. He is in his third battle with prostate cancer and he
represented patients on the guidelines panel.

"If I had heard there was a possibility of preventing the
disease, it certainly would have captured my interest," he said.
But the potential risk of aggressive tumors can't be ruled out, so
doctors owe men a frank talk, he said.

Ernest Bynum, a 68-year-old Cleveland man, started taking
Proscar six years ago. A PSA test was a little high and he was
having urinary problems. When he heard the drug might prevent
cancer, it sealed his decision.

"If it's a possibility of giving me a longer life, I want
that," he said.
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On the Net:
Prevention study:
http://www.cancer.gov/cancertopics/factsheet/pcptqa
Screening advice: http://www.ahrq.gov/clinic/cps3dix.htm#cancer
Risk calculator:
http://deb.uthscsa.edu/URORiskCalc/Pages/uroriskcalc.jsp


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