Background: Whether a male should be placed on a well-studied pharmaceutical agent thought to have chemoprotective properties, is currently a question that is debated by clinicians. The purpose of this study is to determine the benefits versus harms associated with finasteride as a chemoprotective agent. Finasteride, has been used for the treatment of benign prostatic hyperplasia. It has been hypothesized that, since this medication resulted in the reduction of PSA levels, and a decrease in the size of the prostate, it would, in turn have a positive lowering effect on the incidence of prostate carcinoma. A significant number of men will be diagnosed with prostate cancer yearly. This disease may be preventable and is treatable to a certain degree. Screening and prevention modalities have been studied and continue today in an attempt to find better techniques for catching this disease early on. The earlier the cancer is discovered, the greater the chance of survival as there is less likelihood it has metastasized.
Methods: A systematic review of literature over the last twelve years was performed. A thorough literature search was performed using the search engines as follows: CINHAL, Ovid/MEDLINE, and ISI Web of Knowledge. The search was limited to include clinical studies, with English as the primary language. An evaluation of the abstract led to relevant studies, and additional sources were obtained through the bibliography of studies found to lead to other pertinent published information. Numerous studies were obtained and evaluated for relevance and quality. The keywords used included, prostatic carcinoma, prostatic neoplasm, finasteride, and prostatic intraepithelial neoplasia.
Results: A total of four articles were reviewed for this study. Many studies reported that finasteride does result in a reduction of PSA values by approximately half and in a decrease in the volume of the prostate gland. According to the Prostate Cancer Prevention Trial, finasteride was found to have caused an overall decrease in the incidence of prostate cancer in the treatment group, but in the carcinomas detected, they were an overall high-grade of cancer. A subsequent analysis of data from the same trial concluded the incidence of high-grade carcinoma in the treatment group on biopsy was downgraded to a lower-grade cancer at prostatectomy. This analysis demonstrated a narrowing of the gap between the treatment group and the control group in the incidence of high-grade disease. This narrowing was insufficient to confirm that finasteride was not the cause of the increased detection of high-grade cancers.
Conclusion: According to the aforementioned results from this review, it is apparent that finasteride cannot be used as a chemoprotective agent until there is further proof that it does not cause a higher incidence of high-grade disease. Due to the inconclusive data that resulted from such a vast study, more research needs to be performed in this area.
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