June 15, 2008

Debate Surrounds Drug Said to Avert Prostate Cancer


By Gina Kolata

The New York Times

For the first time, leading specialists in prostate cancer say, they have a drug that can significantly cut men's risk of developing the disease, dropping the incidence by 30 percent.

But the discovery, arising from a new analysis of a large federal study, comes with a debate: Should men take the drug?

Prostate cancer is unlike any other because it is relatively slow- growing and, while it can kill, it often is not lethal. Most leading specialists say a major problem is that men are getting screened, discovering they have cancers that may or may not be dangerous, and opting for treatments that can leave them impotent or incontinent.

So should healthy men take a drug for the rest of their lives to avoid getting and being treated for a cancer that, in most instances, it would be better to leave undiscovered and untreated? Is it worth risking a chance that unanticipated side effects may emerge years later if millions of men with no prostate problems take the drug?

Some prostate cancer experts say the answer is yes. Any man worried enough about prostate cancer to be screened might consider it, they say.

The drug, finasteride, is available as a generic for about $2 a day, and millions of men safely take it now to shrink their prostates, its approved use.

With finasteride, as many as 100,000 cases of prostate cancer a year could be prevented, said Dr. Eric Klein, director of the Center for Urologic Oncology at the Cleveland Clinic.

Dr. Howard Parnes, chief of the prostate cancer group at the National Cancer Institute's division of cancer prevention, also is convinced. "There is a tremendous public health benefit for the use of this agent," he said.

While it might seem convoluted to offer a drug to prevent the consequences of overtreatment, that is the situation in the country today, others say. Preventing the cancer can prevent treatments that can be debilitating, even if the cancers were never lethal to start with.

"That's the bind we're in right now," said Dr. Christopher Logothetis, professor and chairman of genitourinary medical oncology at the M.D. Anderson Cancer Center. "Most of the time, treatment wouldn't help and may not be necessary, but the reality is that people are being operated on."

Not so fast, other experts say: Finasteride might not make much of a difference in the death rate, because so few men die of prostate cancer. What the drug's proponents are advocating is taking a drug to compensate for what many believe is overzealous diagnosis and treatment of the disease.

Dr. Peter Albertsen, a prostate cancer specialist at the University of Connecticut, explains: While 10 percent of men 55 and older find out they have prostate cancer, the cancer is lethal in no more than 25 percent of them. So if finasteride reduced the prostate cancer's incidence by 30 percent, about 7 percent of men would get a cancer diagnosis and approximately 1.8 percent instead of 2.5 percent would have a lethal cancer .

how to get drug

Finasteride is available from Merck & Co., as Proscar, and from six companies as a generic to shrink the prostate in older men, whose prostates can enlarge, making urination difficult.

Originally published by BY GINA KOLATA.

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