Some of the investigators involved in the dutasteride studies are recommending using the drug to improve the performance characteristics of PSA testing.
The method they are proposing reduces the sensitivity of PSA testing and would likely miss or delay the diagnosis of half of the high-grade prostate cancers.
Moreover, to me, it is unthinkable to recommend a drug that is associated with more cases of aggressive prostate cancer to “improve” the performance characteristics of PSA testing when its long-term use is associated with more high-grade prostate cancers, and it would change the operating characteristics of PSA to miss half of the high-grade cancers.
In June, the U.S. Food and Drug Administration (FDA) issued new safety information for the labels on 5-ARIs (5-alpha reductase inhibitors)
It includes a warning that taking the drugs increases the risk of being diagnosed with a more serious form of prostate cancer (high-grade prostate cancer).
Drugs in this class are finasteride (marketed as Proscar [finasteride 5 mg] and Propecia [finasteride 1 mg]) and dutasteride (marketed as Avodart). Dutasteride is also available in combination with tamsulosin, under the brand name Jalyn.
These drugs are prescribed to treat symptoms from enlarged prostate, and in the case of Propecia, it is prescribed to treat hair loss.
Also, men and their doctors should be aware that treatment with 5-ARIs causes an approximate 50% reduction in prostate-specific antigen (PSA) values by 6 months; however, individual patients receiving 5-ARIs may experience varying decreases in PSA values.
Therefore, any confirmed increase in PSA while on a 5-ARI may signal the presence of prostate cancer and should be checked out, even if that PSA is in the normal range of men not taking a 5-ARIs.
Doctors and patients should have a discussion about the risks and benefits of the drugs before starting any prescription program.