A new study has reignited a debate about whether men should use a baldness drug to prevent prostate cancer.
The drug, finasteride, is a generic drug now widely used by men to shrink enlarged prostates, and it also has been used to treat male pattern baldness. In 2003, a study of 18,000 men showed that the drug also lowered a man's risk for prostate cancer by 30 percent.
But the Food and Drug Administration never approved finasteride to prevent prostate cancer because of a troubling finding. Although the drug clearly reduced the overall risk for prostate cancer, slightly more men who used the drug developed fast-growing tumors compared with men who took a placebo.
On Wednesday, a follow-up study in The New England Journal of Medicine reopened the debate about the potential benefits of the drug. It showed that 14 to 17 years after the men first enrolled in the study, survival was the same among men who used finasteride as those who took a placebo. That finding, based on a review of Social Security death records, suggested that the drug was not causing the aggressive tumors. Instead, it was more likely that by reducing the size of a man's prostate, the drug made it easier to find aggressive tumors.
The results should be reassuring to men that the drug can safely be used to treat an enlarged prostate. However, the new study also raises questions about whether men should consider using the drug to prevent prostate cancer.
The study's authors estimated that widespread use could save about 70,000 men a year from the emotional and physical trauma of prostate cancer diagnosis and treatment. Using the drug will not prolong their lives or protect them from aggressive cancer, but it will lower their risk for low-grade prostate cancer. As a result, that would mean fewer men would receive unnecessary treatment for that cancer, which was unlikely to ever cause them harm.
Dr. Ian Thompson, director of the cancer therapy and research center at the University of Texas Health Science Center in San Antonio and the study's lead author, said that because large numbers of men with low-grade tumors were treated unnecessarily, often with treatments that rendered them impotent or incontinent, there was a benefit to preventing low-grade, nondeadly cancers.
"It doesn't reduce risk of cancers that take men's lives, but low-grade cancers lead to huge amounts of follow-up testing and treatment," Dr. Thompson said. "With the drug, you just don't find as many cancers, and that's a good thing."
Dr. Peter Scardino, head of the prostate cancer program at Memorial Sloan-Kettering Cancer Center in New York, said he did not expect the finding to prompt doctors to prescribe the drug to prevent cancer. However, it may prompt some men at very high risk of prostate cancer, like those with a family history who undergo regular screening, to take the drug. It could also pave the way for more research into prostate cancer prevention and treatments for men with early-stage prostate cancer.
"It probably means we should be looking harder at the issue," he said. "We have a biological mechanism that can prevent these low-grade cancers, so it leaves the door open for further study. I don't think we've heard the end of this story."
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