Chemoprevention of Prostate Cancer (Maybe)

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A study published today in the New England Journal of Medicine (NEJM) reports that the drug dutasteride (brand name Avodart), currently used to shrink enlarged prostates, was found to reduce the risk of prostate cancer by about a quarter in high-risk men.

This is very exciting, says Dr. Whelan. We often talk about prostate cancer and chemoprevention. One of the drugs we frequently mention is finasteride, or Proscar, since we always suspected that it could reduce the risk of prostate cancer, but now it seems that this new drug might be even more promising. Unfortunately, not many Americans even know what chemoprevention is.

Stier agrees: Many people have an attitude of, I m not taking any drugs unless I m sick. The idea of taking drugs now to reduce your risk of cancer later is not very well known.

A cautionary editorial by Dr. Patrick Walsh of Johns Hopkins James Buchanan Brady Urological Institute appears in the same issue of NEJM. Dr. Walsh argues, 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 (corrected for the effect of the drug) or an abnormal digital rectal examination.

Dr. Walsh suggests that these drugs may be more about window dressing than actual life-saving effects, says Dr. Ross. The study -- and, for the most part, the media -- says, Full speed ahead on chemoprevention! but Dr. Walsh is saying that we need to wait and do more studies on these drugs to see if they actually save lives, rather than merely improving biomarkers of disease.