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The two new data analyses conducted by a team including Ian M. Thompson Jr., M.D., professor and chairman of the Department of Urology, were published in the journal Cancer Prevention Research.
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SAN ANTONIO (May 22 2008) — Two new analyses of data from the national Prostate Cancer Prevention Trial (PCPT) show that the drug finasteride does not increase the risk of high-grade prostate cancer, as experts had earlier suspected, but actually decreased the risk by 27 percent. The studies and an accompanying editorial recommend that physicians prescribe the medication as a prevention agent for all men.

Ian Thompson Jr., M.D., professor and chairman of the Department of Urology at The University of Texas Health Science Center at San Antonio, discussed highlights of the new analyses in a plenary speech May 18 at the American Urological Association Annual Meeting in Orlando Fla. The analyses were also released in the journal Cancer Prevention Research, along with an accompanying editorial.

Experts puzzled by original findings
When the original PCPT results were released in 2003, finasteride was shown to reduce the risk of prostate cancer by 24.8 percent. However, experts were confounded by the drug’s apparent association with a greater risk of high-grade prostate tumors. As a result, physicians were reluctant to prescribe the hormone inhibitor that is generally used to shrink the prostate gland in men with enlarged prostates.

New analyses show that finasteride helps detect high-grade tumors
“These new studies clearly show that finasteride not only prevents slow-growing prostate cancer, but does not cause high-grade cancer,” Dr. Thompson said. “We found that what we thought at first was an increase in high-grade cancer was actually an improved detection rate of high-grade cancer due to finasteride. What happens is that when finasteride shrinks the prostate gland, it makes it easier to find the cancer, so this drug not only prevents slow-growing cancers, but also helps detect and may prevent high-grade aggressive tumors that can be life-threatening to patients.”

Study, editorial recommend finasteride as a prevention agent for all men
Dr. Thompson and the editorial writers both said more clinicians should consider prescribing the medication to all men with the goal of preventing prostate cancer, which continues to be a strong challenge to the public health of men worldwide.

“The results of these analyses effectively eliminate the concern that finasteride caused an increase in aggressive cancers within the study period,” wrote Christopher J. Logothetis, professor and chair of genitourinary medical oncology and director of the genitourinary program at M.D. Anderson, and Paul F. Schellhammer, M.D., program director of the Virginia Prostate Center and professor of urology at Eastern Virginia medical School. Neither author was involved in the PCPT studies.

NCI-funded study was a collaborative effort
National Cancer Institute grants funded the studies, which have co-authors from the Southwest Oncology Group, the Fred Hutchinson Cancer Research Center in Seattle, The University of Texas M. D. Anderson Cancer Center, the National Cancer Institute, and the University of Colorado at Denver and Health Sciences Center.

The PCPT was designed to test whether finasteride would prevent prostate cancer in men ages 55 and older. The study was closed in June 2003 — 15 months prior to the expected final date of follow-up — because the study objective had been reached. The results of the study, “The Influence of Finasteride on the Development of Prostate Cancer,” were published in the New England Journal of Medicine on July 17, 2003. Dr. Thompson was principal investigator of that study and has been involved in virtually all of the follow-up analyses.

Dr. Thompson, one of the country’s most eminently recognized urologists, occupies the Henry B. and Edna Smith Dielmann Memorial Chair in the Health Science Center School of Medicine and the Glenda and Gary Woods Distinguished Chair in Genitourinary Oncology at The Cancer Therapy & Research Center at the UT Health Science Center. He is vice chair of the National Cancer Institute Early Detection Research Network.

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