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Benign prostatic hyperplasia: Caveat for finasteride should be discussed before prescribing

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7569.654 (Published 21 September 2006) Cite this as: BMJ 2006;333:654
  1. Hussam Ammar, attending physician (drmalani{at}yahoo.com),
  2. Ashok K Malani, attending physician, internal medicine,
  3. Chakshu Gupta, physician, laboratory medicine and pathology
  1. Heartland Regional Medical Center, 5325 Faraon Street, St Joseph, MO 64506, USA

    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.

    Footnotes

    • Competing interests None declared.

    References

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