Thursday, March 17, 2011

Prostate Cancer Prevention: Is Avodart Friend or Foe?

Whenever I discuss prostate cancer prevention with my patients, the topic of  Avodart always comes up.  Avodart  ( Dutasteride is the generic name) is a hormonal medicine that is used to treat urinary symptoms associated with BPH (benign prostatic hyperplasia) in men with very large prostates.  It has been shown to work synergistically with another class of drugs called alpha blockers ( Hytrin, Cardura, Flomax) to help improve urinary symptoms and prevent urinary retention.  The way Avodart works is that it blocks an enzyme located in the prostate which converts the male hormone Testosterone to a more potent hormone Dihydrotestosterone.  By blocking this hormone, Avodart actually causes the glands of the prostate to shrink, allowing urine to more easily flow through it.

If Avodart is a medicine used to treat BENIGN enlargement of the prostate, why does it come up in conversations about prostate CANCER prevention?  The answer to that question comes in the form of a landmark study called the Prostate Cancer Prevention Trial which was published in the New England Journal of Medicine in 2003.  This study evaluated a drug similar to Avodart called Proscar (Finasteride is the generic name) in over 10,000 men.  The theory of the study was that the medicine can not only shrink normal glands in the prostate but also prostate cancer glands as well.  In so doing, the authors thought, Proscar could actually prevent small areas of prostate cancer in the prostate from growing and developing into full blown cancer.  The study had some groundbreaking and yet confusing results.  The authors demonstrated that taking Proscar could decrease the risk of prostate cancer by 25%.  This was truly an astounding discovery!  Unfortunately, however, it came with a catch.  The men who did get prostate cancer while taking Proscar were 27% more likely to have a more aggressive, life threatening form. 

The results of the Prostate Cancer Prevention Trial really put patients and urologists in a tough situation.  On one hand, Proscar significantly decreased the overall risk of prostate cancer.  On the other hand, however, those that did get prostate cancer got a more aggressive form.  Numerous theories were offered to explain these conflicting findings.  Some doctors argued that by shrinking the prostate, Proscar only helped to FIND the more aggressive prostate cancer on biopsies because the cancers were more noticeable with less benign prostate tissue around.  Others maintained that by shrinking the normal glands, Proscar allowed aggressive prostate cancer to grow without restriction in the prostate.  Taking all of this into account, experts finally recommended that men who have enlarged prostates that would benefit from Proscar from a urinary standpoint should still be offered the medicine.  In terms of prostate cancer prevention, however, the substantial benefits and risks meant that the medicine had to be considered on a patient by patient basis.

A few years after the Prostate Cancer Prevention Trial, a new medicine called Avodart was brought to market.  As I mentioned, this medicine, like Proscar, blocked the enzyme transforming Testosterone into a more potent compound called Dihydrotestosterone.  Avodart had the added advantage in that it blocked two forms of this enzyme as opposed to Proscar which only blocked one.  The theory is that Avodart may be more effective because of this additional enzyme which it blocks. Given this new drug, another large study was carried out to determine if it could prevent prostate cancer as well.  Called the REDUCE trial, the study compared the risk of cancer in over 3,000 men who took Avodart as compared to another 3000 similarly matched men who did not.  The study found that Avodart decreased the risk of Prostate Cancer by 23%.  In addition, over the 4 year course of the study, no difference in high grade, aggressive cancers was noted between the two groups.  Interestingly, however, in the last 2 years of the study, 12 of the patients taking Avodart developed prostate cancer as opposed to only 1 of the patients not taking it.  Once again, like Proscar, while Avodart appeared to reduce the overall risk of prostate cancer significantly, it appeared to also increase the chance that people who did get prostate cancer would have more aggressive variants. 

Recently, a request was made to the FDA for approval to market Avodart and Proscar for the indication of prostate cancer prevention.  The committee rejected the proposal unanimously.  They felt that the benefits of prostate cancer prevention did not outweigh the risks of at least potentially causing more aggressive prostate cancer in some patients.  So what is the take home message of all of this information?  Is it to tell you not to ever take Proscar or Avodart?  No. People who would benefit from it from a urinary standpoint should consider it.   The point of the post is simply to inform you that trying to prevent prostate cancer with these medicines is not a straightforward endeavor.  If your doctor recommends that you take these drugs solely to prevent prostate cancer, make sure you discuss these risks with him or her and are comfortable that they are worth taking.


Check out my new Book: 

13 comments:

  1. What are urologists actually doing? Is anyone actually prescribing dutasteride or finasteride for chemoprevention, when it is not otherwise indicated for BPH / urinary symptoms? (I understand that would be off-label).

    You wrote, with respect to the REDUCE trial "it appeared to also increase the chance that people who did get prostate cancer would have more aggressive variants." Is that right? My reading of the REDUCE study suggested there was no statistically significant increase in high-grade cancers in the treatment group when compared to the control group (unlike in the PCPT study).

    ReplyDelete
    Replies
    1. THANKS TO DOC ONIHA WHO CURED ME OF PROSTATE CANCER, I SUFFERED SEVERE PAINS FOR THREE YEARS WITHOUT ANY MEANINGFUL RESULT, UNTIL I CAME IN CONTACT WITH DR ONIHA TESTIMONIES ONLINE ON HOW HE HAS BEEN CURING PEOPLE OF PROSTATE CANCER WITH HIS HERBAL MEDICATI0ON, AND I GAVE IT A TRY, WITHIN FOUR WEEKS I WAS CURED COMPLETELY, IN CASE YOU ARE GOING THROUGH SIMILAR PROBLEM, YOU CAN ALSO CONTACT HIM ON HIS EMAIL: DRONIHASPELL@YAHOO.COM OR WHATSAP HIM ON +2347089275769.

      Delete
  2. chamorgadol: I and most other urologists do not prescribe Dutasteride or Finasteride unless that patient has a large prostate and urinary symptoms for the reasons mentioned in the post.

    In the REDUCE trial there was no statistically significant increase in high grade cancers for those on Dutasteride if you look at the trial as a whole. However, if you look at the last 2 years of the study, 12 of the Dutasteride patients were found to have high grade cancers as opposed to only 1 of the placebo patients. It is this data that compelled the FDA to reject the application.

    ReplyDelete
  3. You can buy original Avodart for less than 35 dollars/month from proscar.tictail.com

    ReplyDelete
  4. Good nutrition, healthy lifestyle, appropriate weights are effective in prevention of prostate problems.

    Ask your doctor for the supplements you need. Watch out for eating spicy foods that can be a cause of irritation of prostate.

    Lessen red meat and saturated fat in the diet and eat more fruit and vegetables. Also try to avoid soda too much caffeine and alcohol to maintain prostate health.
    entrusted extenze website

    ReplyDelete
  5. The main reason it is so difficult to choose the right semen enhancement capsule is that the consumer is a novice. Someone who has purchased a number of male enhancement products over the years likely knows which name brands are the tops and which ones are the pits.
    helpful volume pills

    ReplyDelete
  6. Quite a number of men wish they had a larger penis. While many will say size does not matter, the truth is men who want a larger penis have their own reasons for their wishes.

    If a viable method of enlarging the penis exists, they should look into their options. Not very many males who want a larger size really know what to do to achieve enlargement. defining malextra website

    ReplyDelete
  7. Many people believe mistakenly that cardio is all about going to the gym and running on the treadmill. If you don’t like the gym, you can choose among a vast range of alternative possibilities.

    Some of the most effective forms of aerobic exercise include biking with your kids, having a jog in the park, climbing the stairs, swimming, rowing (one of the most effective fat burning aerobic exercises), skiing and even walking. fuller prosolution plus

    ReplyDelete
  8. Positive site, where did u come up with the information on this posting?I have read a few of the articles on your website now, and I really like your style. Thanks a million and please keep up the effective work. asbestoscancer.org/pericardial-mesothelioma/

    ReplyDelete
  9. Cancer is not just a health issue, but a phase of life too. If you take care of yourself properly, you will win any battle in life. Etizolam Online

    ReplyDelete
  10. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are Clara David I’m a citizen of USA, My younger sister was sicking of
    breast cancer and her name is Sandra David I and my family have taking her
    to all kind of hospital in USA still yet no good result. I decided to go to
    the internet and search for cancer cure so that was how I find a lady
    called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the roots and herbs to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man @herbalist_sakura for my younger sister help to cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be
    cure, he told me that there is a medicine that he is going to give me that
    I will cook it and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in USA, he told me
    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week
    complete my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor so my dad wanted to pay him 5 million us dollars the
    herbal man did not accept the offer from my dad, but I don't know why he
    didn't accept the offer, he only say that I should tell the world about him
    and his miracle he perform so am now here to tell the world about him if
    you or your relative is having any kind of disease that you can't get from
    the hospital please contact dr.sakuraspellalter@gmail.com or whats app him
    +2348110114739  you can follow him up on Instagram @herbalist_sakura for the cure, he will help you out with the
    problem. And if you need more information about the doctor you can mail me
    davidclara223@gmail.com 

    ReplyDelete

  11. I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
    liver already present. I started on antiviral medications which
    reduced the viral load initially. After a couple of years the virus
    became resistant. I started on HEPATITIS B Herbal treatment from
    ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
    treatment totally reversed the virus. I did another blood test after
    the 6 months long treatment and tested negative to the virus. Amazing
    treatment! This treatment is a breakthrough for all HBV carriers.

    ReplyDelete
  12. I’d commend using Dr. Utu Herbal Cure topically for instant pain and itch relief as well as accelerated healing of lesions and permanently stopping herpes virus outbreaks. I have tried just about everything from acyclovir suppressive therapy to different natural oils, extracts, and other natural methods, some of which are EXTREMELY painful and exacerbate the problem (i.e. apple cider vinegar!). While vitamin E oil and suppressive therapies worked well for me, when I became pregnant I went back to trying to find a herbal cure. I was using vitamin E oil topically for a while but it was thin and difficult to use and only seemed to prevent further outbreaks rather than getting rid of it. I contacted Dr. Utu Herbal Cure through my friend. To my surprise, I could tell my outbreak was starting to heal within only a few hours! No more itching and pain! Dr. Utu Herbal Cure that I used was liquid herbs in bottles, so it was very easy to use. It simply whiffs, but it works so I don’t care! The best part of my testimony was that I successfully delivered a herpes-free beautiful daughter without further medications. Anyone who has tried Dr. Utu Herbal Cure knows just how quickly those treatments can add up.
    Anyone can reach Dr. Utu through
    drutuherbalcure@gmail.com
    +2349072733661

    ReplyDelete