April 07, 2010
Dutasteride Cuts Prostate Cancer Risk?

Do drugs that block the conversion of testosterone into dihydrotestosterone reduce the risk of prostate cancer?

Results from a large, randomized clinical trial indicate that men at an increased risk for prostate cancer reduced their risk with regular use of the drug dutasteride (Avodart). The results came from the REDUCE trial, which is the second largest clinical trial to demonstrate a decreased risk of prostate cancer in men taking an agent from the class of drugs known as 5-α reductase inhibitors (5-αRIs). Previously, the Prostate Cancer Prevention Trial (PCPT) showed that the drug finasteride had a risk reduction similar to what has now been seen in REDUCE.

These drugs also slow or stop male pattern baldness as well as controlling benign prostate hyperplasia. So one could take them for one of the certain benefits with the hopes of getting an additional anti-cancer benefit.

The study included 4 years of follow-up. So it doesn't tell a guy who is, say, 40 whether it is worth taking dutasteride for decades in order to cut long term risk. Does dutasteride reduce the conversion of prostate cancer cells into cancerous cells? Or does it just slow the growth rate of cells that are already abnormal and cancerous?

The international trial involved more than 6,700 men between ages 50 and 75 who, at enrollment, had a prostate-specific antigen (PSA) test score between 2.5 and 10 and a negative biopsy in the prior 6 months. Participants, the large majority of who were white, also received biopsies 2 and 4 years after enrollment. After 4 years of follow up, there was a nearly 23 percent reduction in the relative risk of prostate cancer in men who took dutasteride compared with those who took a placebo (659 cancers versus 858 cancers).

I'm mildly tempted to start taking dutasteride or finasteride and keep taking it for decades. Maybe it'll cut the risk of prostate cancer. But read the debate on finasteride and dutasteride versus prostate cancer if you are thinking about taking one of them.

I really wish there were more drugs worth taking for long term risk reduction. For example, daily statin drug usage might also deliver a long term benefit even for some with low cholesterol. Again, I read such reports but am reluctant to take drugs and so I hold back. As the link about statins shows, they have their own risks including elevated risk of type II insulin-resistant diabetes. Here is a a New York Times article on statin risks for healthy people.

I wish genetic tests for drug side effect prediction were already mature and widely available. I'd like to know my own specific risks for muscle or memory side effects from statins or other side effects from dutasteride. The trade-offs from long term drug use for risk reduction will become clearer for individuals once genetic markers for drug side effects become known for the major drugs.

Share |      Randall Parker, 2010 April 07 10:18 PM  Aging Drugs


Comments
Tony D said at April 8, 2010 10:38 AM:

Randall, I'm 26 and have taken Propecia since I was 17. At age 25, when I found out about Avodart, I switched over to it and I am currently taking it. The reason? Hair loss of course! Not only do I have a full head of hair thanks to this and other habits, but hearing about it's anti-cancer properties is a huge added bonus as well. No side-effects because I am strict with the dosage. My advice? Do take it if you can budget that amount every month and it's worth it rather than the renewing therapies you have told us to budget for. (I live in a third world country where the cost for Avodart is half of what it is in the US)

Another thing: you mention taking medicines to reduce problems down the road. Why aren't you on Metformin?

Randall Parker said at April 8, 2010 7:03 PM:

Tony D,

Cost: Not my major concern. I'm more worried about side effects. It is very difficult to lower all-cause mortality. I can understand taking, say, statins if one is at high risk. But the lower one's risk from the disease one is trying to avoid the more one should concern oneself with side effects.

Avodart: So how are you doing with side effects?

One should take Metformin to avoid type II diabetes? Or what?

Tony D said at April 11, 2010 7:37 PM:

Yeah, Metformin plays a part in Kurzeil's program, and many doctors and non-doctors advocate that people over the age of 30 take it because we supposedly grow more diabetic as time goes on. Tons of information on this. However, it's also a very potent anti-oxidant and it derives from a natural source, a plant. In terms of anti-aging, it's the only true anti-aging medicine I have encountered, but it's still thought of mostly as a diabetic drug. In terms of prevention, it's something to consider. I tested some out, but I went on carb overload after that because it seemed to have made me hypoglecemic. However, I have put both my mom and dad on it.

No side-effects seen with Avodart, as a 185-198 lb person, with 0.5 mg per day. I need to get my sperm tested to ensure that it's okay, but all the rest is okay. No decrease of libido. No ejaculation disorders. In fact, I found that sometimes Propesia made my libido increase, which there probably is a scientific explanation about, free testosterone, etc.

Keep these great updates coming! Appreciate your work.

Nick G said at April 12, 2010 8:29 AM:

Randall,

If you don't mind my asking - what supplements/medications do you take on a long-term basis?

Randall Parker said at April 12, 2010 5:42 PM:

Nick,

Per day: 3 cal/mag/zinc tablets, 2000 IU vit D (sometimes 4000), 3 fish oil caps (1800 omega 3s).

I take a 2400 mcg vit K (1400 K2, 1000 K1) about once every week or two.

Sometimes I take various vit B tablets. But not often. I've taken vitamin A regularly in the past but not lately. Might start taking it again. I also drink beer a few times a week for the boron.

I do not take any drugs. I'm inching closer to regular drug taking. Probably will start with dutasteride or finasteride when I do.

So are dutasteride, metformin, growth hormone, testosterone, and other drugs worth taking long term? The answer is not clear to me.

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