November 14, 2009
Drugs Better Than Diet For Cancer Prevention?
Gina Kolata, writing in the New York Times talks to a lot of top medical researchers and reports on cancer-preventing drugs that go unused and the many disappointing diet and vitamin interventions for cancer prevention.
Many Americans do not think twice about taking medicines to prevent heart disease and stroke. But cancer is different. Much of what Americans do in the name of warding off cancer has not been shown to matter, and some things are actually harmful. Yet the few medicines proved to deter cancer are widely ignored.
The article does an excellent job of reviewing assorted great hopes for reduced cancer risk via diet and vitamins and how many of these approaches failed in large scale intervention trials. Biogerontologist Aubrey de Grey probably doesn't find this surprising since he argues that if micronutrients could deliver large benefits we'd probably carry mutations to up their concentrations in our bodies. There is a counter evolutionary argument though: an antioxidant in higher concentrations might make us less fit in the short term and therefore would have been selected against.
I'm willing to use drugs to cut cancer risks. The drugs finasteride and dutasteride (both used to stop hair loss and treat swollen prostates) would eliminate over a quarter of all prostate cancer cases per year if taken long term to protect against prostate cancer.
A large and rigorous study found that a generic drug, finasteride, costing about $2 a day, could prevent as many as 50,000 cases each year. Another study found that finasteride’s close cousin, dutasteride, about $3.50 a day, has the same effect.
Did she say $2 per day? I used a drug price comparison web site and found Costco selling finasteride for $1.19 per 5 mg tablet in quantity 100. A 10 year supply would set you back about $4400. Having helped someone die from prostate cancer that seems like a very low price to pay to avoid a horrible end. Heck, you can do even cheaper abroad and this is a generic drug. You won't be ripping off intellectual property by buying abroad.
I'm already tempted to ask a doctor to prescribe finasteride or dutasteride. Preserve hair, avoid prostatic hyperplasia (where the prostate slows urine flow), and avoid prostate cancer. I mean, why not? The side effects are said to wear off after a year. Any readers taking it? One concern: what other effects come from lowering dihydrotestosterone? Does regular testosterone also rise as a result?
Tamoxifen cuts the risk of breast cancer in half. An osteoporosis drug, Evista, does the same thing with fewer risks.
Then, in 1999, he had a chance to do another breast cancer prevention trial, this time of an osteoporosis drug, raloxifene, or Evista, which did not have the cancer drug taint. It was to be compared with tamoxifen.
The $110 million study, involving 19,000 women, ended in 2006. The two drugs were found to be equally effective in preventing breast cancer, but with raloxifene there was no excess uterine cancer and the clotting risk was 30 percent less.
I've considered finasteride for hair loss but I'm concerned what it's role is in the brain and its effect on personality. If I could cut my cancer risk and reduce balding without messing with my hormones it would be a no-brainer.
The problem with finasteride is that oral use will cause chemical castration, as well as a subtle feminizing effect. This is doubly true for dutasteride. I use finasteride to prevent head hair loss by grinding up the tablets and adding the resultant powder into the topical Rogaine solutions that I use (the stuff does absorb through the scalp). I will do the same for dutasteride once my supply of finasteride runs out (I buy it cheap from international suppliers cheaply through the internet. It is par for the course for the NY Times journalist who wrote the article to not point out these issues with oral use of finasteride and dutasteride.
I'm glad to hear that about finasteride. I've been taking it for 3 years for hair loss prevention. When I was researching it in 2006, the data seemed solid that it significantly reduced hair loss.
In the studies, not many people have side effects, and in my case I didn't detect anything. One thing to remember: if you stop taking it after you started, or take it inconsistently, hair loss could be worse than if you never started.
1. I purchase finasteride from www.inhousepharmacy.com/generics/finpecia.html. Inhouse Pharmacy is a company in India that seems to have a good reputation, and it also sells more serious medications like treatments for AIDS.
2. I've also received this advice, which sounds good: "The excellent book "Rule the Web" has a tip on this. They recommend a couple of sites- http://pharmacychecker.com/ : updated list of highly rated pharmacies. They say kwikmed.com gets good ratings - http://pharmacychecker.com/profile.asp?WId=89 "
3 thoughts on hair loss (in case it's useful to anyone)
1. I also use the topical Revivogen Scalp Therapy during the morning and night. I wet and then dry my hair first so the solution doesn't get wasted soaking into my hair. Last I checked, the science underlying Revivogen seemed good, and if I miss an application of the solution, the hair follicles on the front of my scalp hurt a little, which seems to be a reasonable indication that it's doing something.
2. I found www.hairlosstalk.com to be the most useful resource site and forum for hair loss. I haven't done research since 2006, though.
3. If my hair loss progressed to a point that I was unhappy with it, I'd consider getting a wig. That's what the PUAs (pick up-artists) and men and women in showbiz do. (Shocking: Beyonce doesn't really have wavy blond hair.)
The first study on this concluded that it just makes prostate cancer easier to spot. And, like the other poster mentioned, affects hormone regulation. What it does to all-cause mortality is unknown because they haven't studied that.
What we really need is a better system for drug research.
I think the order of thinking was initially it looked like finasteride upped the incidence of prostate cancer. But further investigation led to the conclusion that it just allowed earlier diagnosis by shrinking the non-tumor part of the prostate. But then it is my understanding that in the longer run use of finasteride reduced the incidence of prostate cancer.
I agree about the all-cause mortality question. That's the bottom line. We do not know the answer on that. I'm tempted to take finasteride on the speculation that it might reduce all cause mortality.
Can you point to any specific research on the role of DHT in the brain?
> The problem with finasteride is that oral use will cause chemical castration, as well as a subtle feminizing effect.
That's total BS. When I started taking finasteride (1.25mg/day) for hair loss 12 years ago, I read the studies very carefully. 3% of the men reported a difference in their sexual functioning compared to 2% of the people in the placebo control sample. It's probably not even statistically significant.
The only effect that I have ever noticed was that I grew back about a years worth of lost hair and then stopped losing it. I even stopped using it for a few months to see if I noticed any side effects. I didn't. I've also had several kids over the last 10 years, so apparently the chemical castration hasn't kicked in yet.
Today when I tell men losing their hair that I take finasteride the most common response is "Why?! You're not losing your hair."
I wonder if taking quarter doses has the same cancer-inhibiting effect...
Do you regain hair in the temporal region?? I am not aware of any drug that can do that.
To the owner of futurepundit: we techies/futurists types need to use crowd sourcing to track all cause mortality.
As a group, we contain more people capable of executing such a study and the willpower and foresight to implement the results. If one is certain of an after life, not much use in trying to prevent cancer (before one gets it!).
Taking drugs like this to prevent cancers is currently premature. But I suspect the time will come.
As an aside, even at $2/day, you're still be treating a LOT of people to save ~25% of prostate cancers (IF that number holds up). Even if 20% of men get prostate ca, giving it to everyone would only benefit ~25% of those, meaning you'd be treating 100 men to benefit 5 (eg 95% get NO benefit... other than flowing locks of hair). Additionally, may prostate cancers are minimally aggressive and fail to cause problems in the individual's lifetime. I suspect that these (being more highly differentiated) would be more sensitive to finasteride. IOW, we don't know how much real benefit would be derived... without extensive studies. If you're going to treat everyone, I'd expect that you'll see the appearance of heretofor unknown side effects etc.
Not a no-brainer anyway.
Right, the focus should be on methods to fight ageing. But what to do in the mean time? It could easily be a century or two before ageing is given the attention it deserves (and of course no one currently in existence will benefit if that is the case).
However, it might be that many alive today could benefit if they just lived 5 or 10 years longer, which is plausible with environmental intervention. And then, of course, if living 10 years longer means, say, an extra 50 years, than it's very easy to argue that such a technique or drug is worth it. Unfortunately, we need a drug that lowers all cause mortality. Besides vitamin D, exercise, caloric restriction, there isn't anything we can do and all 3 may have little or no effect on life expectancy. Ex: perhaps you already have plenty of sunshine and happen to live in a smog free city, have the right kind of cholesterol sub-type flowing through your nervous system, and managed not to get infected by a virus that could have used up your t-cells in old age - and thus die from the flu.
We need a site where people can report what drugs they are taking long-term. Every willing person could create an account and report some details. But I wonder how much in the way of details we'd need to pull off something like this. I'm going to start looking for ways to explore this idea.
The finasteride and dutasteride also will prevent many cases of prostatic hyperplasia. I wonder what other benefits it would deliver. I've read that a swollen prostate is associated with increased incidence of kidney failure. Perhaps having an on-average more full bladder might be the mechanism of action.
Yes, BPH will be reduced, though kidney failure secondary to BPH must be rare (I've never seen it nor heard of any of my colleagues having a patient with that... though I'm not a urologist).
Looking even more carefully at the numbers, only 1 in 35 men die of prostate ca. So now you're talking about treating ~99.2 men out of a hundred to prevent 0.8 prostate cancer deaths... and that's if the 25% reduction in cases translates over to the deadly forms of prostate cancer (which it may not). And for how long? 10 years? 20? 30?
I would advertise at my school (UTD) once the program got off and running.
Interestingly, we recently had T. Boone Pickens at our brain health center: http://www.brainhealth.utdallas.edu
The irony is that we are wasting a great deal of money teaching students who don't care knowledge they don't need or will forget for no purpose but self delusion while in the midst of a budget crisis. My sister took ap chem and wound up getting a master's degree in it.
If society expected people to be smarter and more efficient with funds, the effect on our lives would be immense. I am going to try and flesh out these ideas when I get time. A significant part of the problem isn't religion. Few people want to die awful deaths, they'd rather just not think about it. No, the problem is the belief that nothing can be done.
Such a website sound easy to set up, but what to measure is an immense challenge. With the advent of cheap genetic tests, such a website could be a literal gold mine. It would seem like even congress would want to help if the right celebrity scientists stepped forward.
Some of the guys who get prostate cancer but die from something else still undergo damaging radiation treatment that is painful, tiring, and likely life-shortening.
BPH incidence is high and half of all BPH cases have some bladder draining outlet obstruction
- The incidence of BPH is at least 50 percent for all men at the age of 50 and rises to at least 80 percent of all men in their eighth decade of life.
- Only about 50 percent of men with BPH have an obstruction at the outlet of their bladder.
Seems like a daily 5 mg of finasteride for guys over 50 could deliver a big benefit. I still want to know about what downsides there are to lowering DHT though.
sorry for another post so quickly but I saw this and was intrigued:
"Fighting Rapidly Declining Youth Reasoning Skills
Center for BrainHealth receives $6 million grant from Texas Legislature"
if it works it will be implemented across all of Texas.
My question: why does this article not mention Vitamin D? D appears to be far more important than any other single vitamin or supplement, with proven strong prevention properties.
A 77% reduction in cancer rates!
BPH is common, yes (though not quite as high as the article you cite suggests). But serious BPH is not as common (eg BPH requiring surgery). Also your chance of prostate cancer goes down after BPH surgery.
And yes, prostatectomy and radiation therapy do have side effects and complications. But do medications like finasteride prevent those cancers that require such treatments or just the minimally aggressive prostate cancers that ordinarily go undiagnosed and can be ignored?
Finally, it is possible that drugs like this may simply push back the appearance of a cancer by X number of years rather than actually preventing such cancers. This may be valuable (though clearly not as valuable as as preventing the cancers completely), again if this effect carries over to aggressive cancers as well as more benign ones.
Ultimately, we'll have to calculate the expected benefits, how many will have to be treated (without any benefit while being exposed to the side effects and costs) in order to benefit one person, and the figure out if that makes sense.
As I said above.. certainly not a no brainer.
BTW, thanks for running this site.
According to experts interviewed by Gina Kolata finasteride really does cut prostate cancer risks substantially. Is the evidence not that strong? They sure sound confident.
Certainly not a no brainer: I agree. On the other hand, I've helped someone die of prostate cancer and I really really really do not want to get it. I want to know how strong the evidence is for 5 alpha-reductase inhibitors as protectors against prostate cancer and whether they are likely to cause undesirable side effects if taken for many years.
According to experts interviewed by Gina Kolata finasteride really does cut prostate cancer risks substantially.
It does cut the risk.... but that's like saying drug X may cut the risk of skin cancer. The majority of which are quite benign in character.
The key will be if finasteride cuts the risk of the aggressive prostate cancers as much as it does the benign acting prostate cancers (without doing so only minimal overall benefit will be achieved). There's good reason to doubt that it would reduce aggressive subtypes as effectively as the benign types (hormone therapy resistant prostate cancers appear to make their own testosterone within the tumor, for example).
It's a question of numbers and effectiveness vs costs. That's why I stated that the idea is premature.
I have been taking Proscar (the cheaper brand name version of Propecia) for four years - and I have noticed only one effect - I grew back some hair and haven't lost any since. No adverse side effects whatsoever. I used to worry about my hair loss - mostly the male pattern hair loss - temples and a little bit on the back of the head - but after about six months of taking Proscar I haven't thought about my hair loss since. I haven't had any to worry about!! I have recommnended it to everyone that has complained about their hair loss.
Pca effects approximately 1 out of 5 males. We just passed prostate cancer awareness month but that shouldn't stop everyone over 40 from getting check out.
To those who say oral finasteride usage does not cause chemical castration, check this out:
This is from a website for those transitioning from male to female (not that there is anything wrong with this). spirolonolactone AND/OR finasteride are the compounds of choice for androgen antagonists. That goes alone with the estrogen to increase feminization of the body.
I took proscar for 2 years (Jan '94 to Nov '95). It was effective chemical castration. I also learned as a result of this experience that male sex drive is necessary for the "openness" that defines who I am. That is, the loss of male sex drive caused depression that was entirely separate from the lack of sex drive itself (I think my transhumanist orientation and desire for opennness and freedom in general, is somehow tied to male sex drive. Feminine nature makes one more inward-oriented, which is not something I am into at this time).
I will check out the Revivogen scalp therapy.
It is my understanding that only a small percentage of finasteride users suffer the effects you experienced.
Did you experience any permanent changes as a result?
No, the changes reversed themselves within one month of replacing oral finasteride with adding it to my topical hair solution (Rogaine, mostly).
I'm currently on dutasteride for an enlarged prostate. The side effect discussed is consistent with my experience, unfortunately. It's only available in one dosage so, with the approval of my physician, I've tried taking it every other day (currently every third day). So far neither the desirable nor undesirable effect seems to change much as a result--but I gather there are sizable time lags for both.
According to my urologist, the evidence on reduced prostate cancer is for the less serious form--he didn't think it was clear whether there was any reduction in the more serious.