Prostate protection in a pill

Twenty years ago, a large-scale, long-term, credible study concluded that men could take a pill that would reduce their chances of getting prostate cancer by a whopping 25 percent. This is not a rare disease: one man in nine will be diagnosed with it during their lifetime. About a third of men have it by the time they're 55, and about 80 percent will have cancer cells in their prostate by the age of 80.

Here in the Naples area, those figures are probably higher because of the average age of our male population. In fact, prostate cancer is the most common kind among men in the U.S.except for non-melanoma skin cancer. For most, it's a slow-burn disease that is not a problem, but it can be difficult to distinguish aggressive tumors from those that pose little threat.

The Pennsylvania radiologist Dr. Saurabh Jha has noted that the prostate "doesn't have the prettiest real estate." It occupies a kind of lower-torso Grand Central of plumbing and electrical systems, wrapped around a close-packed gore of intestines, kidneys, sex organs, and waste disposal routes. Surgery for cancer there is complex, frequently results in impotence and/or incontinence, and is often unnecessary (and that's an article for another time).

So why aren't more men taking that cheap and freely available drug, called finasteride (the trade name is Proscar), to gain its huge protective factor? Partly because of widespread confusion and obsolete information. And, finasteride's occasional side effects indicate that for a small number of men, it's not a good option.

This is a complex story but an important one. Let me begin it for you -- then you can ask your primary care physician or your urologist for the details. That careful 2003 study of nearly 20,000 men did, indeed, show a remarkable reduction in the incidence of prostate cancer among the half of them who took finasteride over seven years. But paradoxically, the data also seemed to show an increased incidence of more serious forms of the disease -- so finasteride did not become the go-to drug for prevention.

Ten years later, however, a more rigorous follow-up analysis showed that finasteride does not generate more aggressive cancers, after all. And it has other benefits, like alleviating the all-too-common problem of frequent urination among older men.

Dr. Howard Parnes, M.D., a prostate cancer researcher at the Division of Cancer Prevention at the National Cancer Institutes notes that "Although finasteride is not FDA-approved for prostate cancer prevention it is approved for the treatment of urinary symptoms due to benign prostatic hyperplasia (BPH)...finasteride is a reasonable choice for the treatment of BPH in that it may decrease a man’s risk of developing prostate cancer while improving urinary symptoms due to BPH."

It is important to note that finasteride can have side effects, he adds, including sexual side effects, though in fewer than 5 percent of men.  So risks as well as benefits should be part of the conversation. The important question for many men is this one, though: have you even had that conversation?