Prostate cancer detection lower in men taking dutasteride for BPH

Among men with benign prostatic hyperplasia, prostate cancer is detected less often in men treated with dutasteride than in those given a placebo according to a report in the September issue of Urology, suggesting that the drug may decrease the incidence of prostate cancer.

The 5-alpha-reductase inhibitors dutasteride and finasteride suppress the potent androgen dihydrotestosterone, the authors explain, thereby inhibiting prostatic growth in patients with benign prostatic hyperplasia (BPH).Dr. Gerald L. Andriole from Washington University School of Medicine, St. Louis, Missouri and colleagues used data from three recently completed placebo-controlled studies to investigate whether dutasteride treatment has a clinically meaningful effect on prostate cancer detection.The cumulative incidence of prostate cancer detected during the first 24 months of dutasteride treatment was 1.1%, the authors report, compared with a cumulative rate of 1.9% in patients treated with placebo.Additional cancers reported between month 24 and month 27 slightly changed the cumulative incidence rates (1.2% for dutasteride, 2.5% for placebo), the data indicate, resulting in a relative risk for detection of prostate cancer of only 0.49 for the dutasteride group relative to the placebo group.The difference in prostate cancer detection emerged only after 15 months of dutasteride treatment, the researchers note.More placebo patients (75%) than dutasteride patients (68%) showed increasing serum PSA levels, the report indicates. Moreover, among 27 subjects with available pathologic data, more dutasteride patients had low Gleason scores, and fewer dutasteride patients had high Gleason scores.”The results from the Prostate Cancer Prevention Trial (PCPT), which shows that finasteride reduces the incidence of prostate cancer, strongly suggest that 5-alpha-reductase inhibition will play a key role in the reduction in risk of prostate cancer development and progression,” Dr. Andriole told Reuters Health.Based on these findings, the investigators write, “the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial has been designed to establish further the efficacy of dutasteride for the chemoprevention of prostate cancer.””We anticipate complete enrollment of the trial by the spring of 2005,” Dr. Andriole said, “and results should be available after participating men complete 4 years of treatment and their end-of-study biopsies.”(Source: Urology 2004;64:537-543: Reuters Health: Oncolink: October 2004.)