Can Drugs Really prevent Prostate Cancer?
   by James Occhiogrosso, N.D.

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According to a new study in the April issue of the New England Journal of Medicine, the drug dutasteride (Avodart) lowers the incidence of prostate cancer, but not the incidence of high-grade tumors.

If you worry about getting prostate cancer, you would have to live on another planet to be unaware of the hype surrounding the use of prescription drugs like dutasteride (Avodart) or finasteride (Proscar) for preventing prostate cancer.

Many men, perhaps even you, may already be using one of the drugs in this family for prostate cancer prevention. But, do they really work, or is this another case of a study designed by a drug manufacturer to produce exactly kind of results that will sell more product? Let's take a more detailed look.

In this latest double-blind study (designed by dutasteride's manufacturer), 6700 high-risk men were randomized to daily dutasteride or placebo. All of the subjects were in the age range of 50 to 75, had PSA levels between 2.5 and 10 ng/mL, and no positive biopsies. The studies hyped result is that during the four year follow-up period, the incidence of newly detected cancer was slightly lower in the treatment group than in the controls. However, The number of high-grade tumors was significantly higher in the treatment group towards the end of the study. Another interesting, but barely mentioned result, was that nearly twice as many men in the Avodart arm of the study developed cardiac conditions, -- potentially a very serious side effect!

Drugs in this class are 5-alpha-reductase inhibitors that might tend to shrink low-grade tumors that would not have been of consequence. However, the more significant results are the increased number of high-grade, aggressive tumors in the Avodart group, and the increase in cardiac problems.

The published study in the NEJM titled "Effect of Dutasteride on the Risk of Prostate Cancer" may give men a false sense of security.  The study concentrates on the potential for reducing the risk of prostate cancer while minimizing effects of the drug that may result in significantly more serious problems. 

Again, note that this clinical trial of dutasteride for preventing prostate cancer was designed and sponsored by GlaxoSmithKline, the manufacturer of dutasteride (Avodart) and its main author is a consultant for GlaxoSmithKline. 

The study's conclusion (copied below from the abstract) makes no mention of the significantly higher detection of aggressive prostate tumors or the nearly doubled risk of cardiac problems among the Avodart group.

"Conclusions: Over the course of the 4-year study period, dutasteride reduced the risk of incident prostate cancer detected on biopsy and improved the outcomes related to benign prostatic hyperplasia."

I don't know how you read this, but I read it as extremely misleading!
And -- that's pretty generous!  Unfortunately, the news media usually picks up only on the headline or conclusion text of a study like this one, and rarely digs deep enough to get to the real facts.     

Make your own decision. The first link below is to the NEJM abstract. The second and third links express some different, perhaps less biased, opinions, and the fourth link is to an article that is typical of many of the news outlets -- it  maximizes the benefits and minimizes the side effects.  

1. Effect of Dutasteride on the Risk of Prostate Cancer (NEJM abstract)
2. Dutasteride Results Reignite Debate About Prevention of Prostate Cancer
3. Drug May Lower Prostate Cancer Risk, But Cause Other Problems
4. International, four-year study finds dutasteride reduces risk of prostate cancer diagnosis in men