Erection Disability Not Associated with Finasteride (Proscar, Fincar) for The Prevention of Prostate Cancer
Prostate cancer is the abnormal growth of cells in a man's prostate gland. The prostate gland is part of the reproductive system of men. It is a doughnut-shaped gland located between the base of the penis and the bladder. It surrounds the urethra, which is the tube through which urine and semen pass. The prostate makes the fluid that nourishes and carries sperm.
The prostate gland is the male organ that produces semen, the milky-colored fluid that nourishes and transports sperm during ejaculation. It sits immediately beneath your bladder and surrounds your urethra — the tube that drains urine from your bladder. During ejaculation, the prostate squeezes this fluid into the urethra, where it mixes with fluid from the seminal vesicles and sperm from the testes to become the ejaculate.
Prostate cancer is the most common cancer in men, after skin cancer. It estimated that approximately 230,110 men in the United States will be diagnosed with the disease this year, and about 30,000 men will die from it.Treatment for prostate cancer can sometimes lead to impotence, urinary incontinence, and other problems, causing a substantial health burden for men.
Finasteride was initially developed in the 1990s for the treatment of benign prostatic hyperplasia (BPH), better known as enlarged-prostate disease, and was first approved by the U.S. Food and Drug Administration for this use. Patients with BPH must strain to pass urine and feel the urge to urinate frequently. BPH can lead to the inability to urinate and urinary tract infection.In 1997 the FDA approved finasteride for the treatment of male-pattern baldness.
Finasteride is used as a treatment in benign prostatic hyperplasia (BPH) in low doses, and in prostate cancer in higher doses. It is also indicated for use in combination with doxazosin therapy to reduce the risk for symptomatic progression of BPH. Additionally, it is registered in many countries for male-pattern baldness.
The treatment of benign prostatic hyperplasia with 5 mg of finasteride per day results in a significant decrease in symptoms of obstruction, an increase in urinary flow, and a decrease in prostatic volume, but at a slightly increased risk of sexual dysfunction.
According to a study published early on the NEJM Web site because of its health implications, men taking finasteride have a significantly reduced risk of prostate cancer, compared with those taking placebo.Prostate cancer developed in 18.4% of men taking finasteride, compared with 24.8% of those on placebo, a significantly reduced risk. However, tumors of Gleason grade 7-10 were found in 37.0% of tumors in men on active therapy, compared with 22.2% of tumors in men in the placebo group.
A combination of drugs is significantly more effective than either drug alone for preventing progression of benign prostatic hyperplasia (BPH), especially in men at high risk for disease progression, according to a study.Trial tested whether finasteride (Proscar), doxazosin (Cardura) or a combination of the drugs could prevent progression of BPH .The combination therapy offers dramatically greater and longer-lasting relief from symptoms and, over time.
Prostate cancer medical treatments commonly employ androgen-suppressive treatments, which cause erectile dysfunction.Finasteride (Proscar) has been associated with impotence in 6 - 19% of patients. Anti-androgen drugs used to treat BPH can also cause erectile dysfunction.
Men with low PSA (prostate specific antigen) levels on screening tests can still have prostate cancer, according to a study. In this study, prostate cancers were detected by biopsy in men with normal PSA levels Most of these men would not have been diagnosed if they had not taken part in this study, since biopsies are not routinely performed in men with such low PSA levels.Lowering the PSA threshold for proceeding to prostate biopsy would increase the risks of overdiagnosing and overtreating clinically unimportant disease.
It's not universally known that finasteride lowers PSA levels in younger men who take it for hair growth.Researchers have known for years that the same testosterone metabolism responsible for prostate growth also causes male-pattern baldness (called androgenic alopecia).The popular hair-growth drug finasteride, taken by millions of balding men, artificially lowers the results of the prostate-specific antigen (PSA) test.Doctors need to ask if they have taken any drugs for hair loss, and the doctors need to multiply the PSA readings.
Finasteride (Proscar) has been associated with impotence in between 6% and 19% of patients. Anti-androgen agents used to treat BPH can also cause erectile dysfunction.
Previous studies shown that Finasteride (Proscar) has been associated with impotence in between 6% and 19% of patients. Anti-androgen agents used to treat BPH can also cause erectile dysfunction. Study over 48 months finasteride produced greater improvements in total symptom score, maximum urinary flow rate, and prostate volume. Significantly more sexual dysfunction, impotence, ejaculation disorder and decreased libido occurred with finasteride at 12 months.
But the sexual adverse events have to be seen against the natural history of reducing sexual performance with age. For instance, sexual dysfunction in men is common and increases with age ; men aged 55 years without erectile dysfunction consider intercourse frequency as being less than adequate . The men in the finasteride trials had an average age of about 65 years.
The effects of prostatectomy on sex function have been well studied. According to one study (Thorpe et al, 1994), prostatectomy is associated with major erectile failures in 12% and absent ejaculation in 24% of cases. The sexual dysfunction found in prostate cancer patients is largely due to the effects of treatment, with radical prostatectomy carrying the highest risk (Helgason et al, 1996). Finasteride, which is used in prostatic enlargement, is associated with loss of libido, erectile failure and reduced volume of ejaculate in 5–6% of men (Gormley et al, 1992).
Another study suggested that the sexual dysfunction found in prostate cancer patients is largely due to the effects of
treatment, with radical prostatectomy carrying the highest risk (Helgason et al, 1996). Finasteride, which is used in prostatic enlargement, is associated with loss of libido, erectile failure and reduced volume of ejaculate in 5–6% of men (Gormley et al,1992).
But most recently when used to prevent prostate cancer, finasteride (Proscar, Fincar) has little effect on sexual function, according to results of the Prostate Cancer Prevention Trial (PCPT), published in the Journal of the National Cancer Institute.
Previous research has suggested an increase in sexual dysfunction associated with finasteride use. But, according to PCPT investigator Dr. Carol M. Moinpour and associates, the studies were relatively small, of short duration, and failed to take into account age, other potentially influential factors, and individual variation.
The PCPT enrolled 17,313 men age 55 and older between 1993 and 1996. Subjects had been randomly assigned to finasteride or inactive "placebo".
Results showed a 25-percent reduction in the occurrence of prostate cancer in the finasteride group, as well as fewer urinary symptoms.
Sexual dysfunction was assessed using the 100-point Sexual Activity Scale, which asks a subject about his ability to have an erection when wanted, degree of satisfaction with his sexual activities, change in sexual performance, and frequency of sexual activities.
From a statistical standpoint, there was evidence that finasteride did, in fact, worsen sexual function compared with placebo. However, the actual magnitude of the effect was small, Moinpour, from Fred Hutchinson Cancer Research Center in Seattle, and her associates note.
"The finasteride effect...was small," and "should not impact the decision to prescribe or take finasteride," the researchers emphasize.
Preventive treatment with finasteride has been shown to reduce prostate cancer prevalence by 25% in a large randomized controlled trial.
Potential implications include an increased rate of high-grade tumors and higher rates of sexual dysfunction among treated men. This decision analysis evaluates the long-term cost-effectiveness of finasteride.