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  • Does proscar increase risk of prostate cancer?

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    Old 02-19-2021, 05:39 PM   #1
    tommy45
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    Does proscar increase risk of prostate cancer?

    My ur wants me to take proscar shrinking my prostate size(110), I brought up same question, my ur said to me that most ur disagree with it. actually proscar prevent cancer. I am confused. Any ideas from member here?

     
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    Old 02-20-2021, 02:43 AM   #2
    DjinTonic
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    Re: Does proscar increase risk of prostate cancer?

    There were some studies and concerns that Proscar might increase the chances of developing high-grade PCa. Subsequent studies found fault with the reasoning of those papers. In addition, it was found that although finasteride does not change the chances of high-grade disease, it does actually lower the risk of low-grade PCa by about 25%. However, it is approved only for BPH and not PCa prevention.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.037 (3 yr. 4 mo.)

     
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    Old 02-20-2021, 01:42 PM   #3
    IADT3since2000
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    Re: Does proscar increase risk of prostate cancer?

    Hi tommy45,

    I have been on Proscar/finasteride or its sister drug Avodart/dutasteride continuously since September 17, 2000, 20 1/2 years ago, to aid in my war against a challenging case of prostate cancer, now apparently cured. I am staying on dutasteride as part of my shield against recurrence. I am highly familiar with this drug and its history.

    I agree with Djin. The fear about this drug stemmed from the fact that more high grade cancers were found in biopsies of men taking the drug, which on the surface looked like a problem. The reality is that these drugs shrink the prostate by substantially reducing BPH, and that means you find more cancer because you are putting the same number of biopsy probes in a smaller volume. Do you see why that is so? I can explain further. In essence, use of these drugs renders both greater efficiency in biopsies and greater confidence in interpreting PSA trends because most or all of the "noise" from BPH is eliminated. In the past few years a very long term follow-up study was published that showed there was no increase in high grade prostate cancer due to finasteride. Various studies have indicated a lower incidence of lower grade prostate cancer due to use of these drugs, especially with longer use; for example, see https://academic.oup.com/jnci/article/110/11/1216/4935092 .

    I watched the whole FDA hearing on Proscar where the issue of high grade disease was debated. Most unfortunately, Dr. Patrick Walsh, MD, the great and pioneering prostate cancer surgeon, advocated against its use against prostate cancer, and against a lot of spirited opposition from highly informed doctors (e.g., Dr. Ian Thompson, MD, a very prominent prostate cancer surgeon, of MD Anderson), and his view carried the day. Subsequent research has pretty much proven him wrong and the opposition right.

    In a small but significant proportion of men, Proscar/finasteride decreases sex drive and erectile function. If that happens, stopping the drug restores drive and function in the vast majority of men, but apparently not all.

    Good luck.

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 02-21-2021, 06:31 AM   #4
    Prostatefree
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    Re: Does proscar increase risk of prostate cancer?

    It can suppress/slow low grade G3 cancer. But, if your PSA continues to rise while using it you may have something more aggressive, smaller, and more difficult to find. Whether anyone still uses it to screen for more serious cancer this way, I don't know.

    It should not be used to avoid biopsies, imo. When was your last biopsy and what is your current PSA? It appears your PSA is rising steadily over the last 10 years.

    Djin's signature is an example of this.

     
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    Old 02-21-2021, 07:09 AM   #5
    DjinTonic
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    Re: Does proscar increase risk of prostate cancer?

    You and your uro have to be careful. Once on Proscar your PSA will roughly halve in a few months. After it reaches its new low, your doc will use a doubling rule. Say your PSA goes from 6.0 to 3.0. If you then rise to 3.4, you consider that as a rise from 6.0 to 6.8. In other words you did not have the significance of a 0.4 rise, but rather a more significant rise of 0.8.

    Proscar and Flowmax worked very well for years in controlling my BPH symptoms, but eventually my prostate growth won the battle and I needed a procedure. I chose a TURP.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, negative frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.037 (3 yr. 4 mo.)

     
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    Old 02-21-2021, 04:03 PM   #6
    GuyBMeredith
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    Re: Does proscar increase risk of prostate cancer?

    Dr. Walsh is good about presenting quite a bit of information on prostate cancer, but I've caught him repeating some misinformation as well.
    __________________
    Diagnosed at age 73 Feb 2019 DRE indicates nodule PSA 2.8 Aug 2019 PSA 3.1 Urologist suggests biopsy in Oct Results of biopsy: 2 of 12 cores positive. Low volume T2b, intermediate risk, GS 3+4, PSA 3.10, prostate cancer, perineural invasion. Followed up with MRI to help decide between surgery and IMRT. MRI shows suspicious PIRADS 5 lesion measuring 2.cm in diameter, with associated left neurovascular bundle involvement. Started 6 month lupron series Feb 2020, 28 sessions of high dose IMRT Apr 15, 2020. Sexual functions okay except ejaculate has changed. Without libido it is an academic process that requires much focus. July 27 first measure of PSA and total testosterone. PSA: .13 ng/dl Total testosterone is less than 12 ng/dl.

     
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