Finasteride, a 5-alpha reductase inhibitor has been implicated a potential drug which can reduce the risk of developing prostate cancer. This was concluded (that there is about 25% less chance of developing Prostate cancer with Finasteride use) after PCPT (Prostate Cancer Prevention Trial) started almost 18 years ago and included about 18000 patients. However, this promising finding was overshadow by subsequent analysis which showed that high grade Prostate cancer (Gleason 7-10) were more common in patients who were taking Finasteride than Placebo (p=0.05).
Recently, the same group analyzed and published the long-term rates of survival among all study participants and among those with prostate cancer with 18 years follow up (Thompson et al. N Engl J Med 2013; 369:603-610). They concluded that Finasteride reduced the risk of prostate cancer by about one third. High-grade prostate cancer was more common in the Finasteride group than in the placebo group, but after 18 years of follow-up, there was no significant between-group difference in the rates of overall survival or survival after the diagnosis of prostate cancer.
Prostate cancer prevention, screening and treatment guidelines have been continuously evolving based on many large studies from North America and Europe. This study is certainly going to reignite the discussion on Prostate cancer prevention. It appears to me that use of Finateride can reduce the risk of developing low grade Prostate cancer and thereby can reduce the side effects associated with treatment of non life threatening Prostate cancer.