BMJ  2006;333:654 (23 September), doi:10.1136/bmj.333.7569.654

Letter

Benign prostatic hyperplasia

Caveat for finasteride should be discussed before prescribing

EDITOR—Patel and Chapple recommend finasteride as one drug in combination therapy of benign prostatic hyperplasia.¹ Finasteride was evaluated for chemoprevention of prostate cancer in a seven year, placebo controlled study of 18 882 men at low risk of developing prostate cancer.² Patients who received finasteride (5 mg/day) had a 25% lower incidence of prostate cancer. However, they also had a higher incidence and a greater proportion of high grade cancers. This is unlikely due to finasteride artifact.³ Since finasteride lowers serum levels of prostate specific antigen (PSA), it may also delay a prostate biopsy in asymptomatic men, allowing proliferation of high grade cancer.⁴ The authors have rightfully cautioned readers to use lower reference values of PSA when screening patients taking finasteride. This caveat should be discussed with patients before prescribing finasteride for benign prostatic hyperplasia.

drmalani{at}yahoo.com

Heartland Regional Medical Center, 5325 Faraon Street, St Joseph, MO 64506, USA

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Competing interests: None declared.

References

1. Patel AK, Chapple CR. Benign prostatic hyperplasia: treatment in primary care. BMJ 2006;333: 535-9. (9 September.)[Free Full Text]
2. Thompson IM, Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med 2003;349: 215-24.[Abstract/Free Full Text]
3. Yang XJ, Lecksell K, Short K, Gottesman J, Peterson L, Bannow J, et al. Does long-term finasteride therapy affect the histologic features of benign prostatic tissue and prostate cancer on needle biopsy? Urology 1999;53: 696-700.[CrossRef][ISI][Medline]
4. Scardino PT. The prevention of prostate cancer—the dilemma continues. N Engl J Med 2003 Jul 17;349(3): 297-9.[Free Full Text]

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Relevant Article

Benign prostatic hyperplasia: treatment in primary care

Anand K Patel and Christopher R Chapple
BMJ 2006 333: 535-539. [Extract] [Full Text] [PDF]