1. Medicines are dangerous things. They can save one thing and harm another.

Posted at 5:28PM on Dec 5th 2006 by Louis

2. Kristina, Louis, and interested friends,

Propecia in itself is not dangerous, though ignorance of its effects can be. And, the main thrust of this new D'Amico/Barry study is a very important further confirmation of the safety and effectiveness of finasteride (the generic for Propecia and Proscar - the difference is in the dose) treatment in aiding detection of prostate cancer. Dr. D'Amico's great prestige should help sway a medical establishment that often seems sluggish in adapting to useful developments, in this case, helping with prevention and detection of prostate cancer.

Thanks very much for pointing out this key new study, which was fresh news to me.

I've been following developments involving Propecia, and its higher dose cousin, Proscar, which I've taken continuously since 2000 (to help with prostate cancer), for a long time. I've learned a few important facts.

Dr. Anthony D'Amico is a premier researcher -- very highly respected for his prostate cancer work. He is arguably the world's foremost expert in the area of PSA velocity as an indicator of prostate cancer and its severity. He is highly knowledgeable about Proscar.

Mindful of his research, and after several years of analysis, leading experts involved in a stunningly successful trial using finasteride to lower the risk of prostate cancer (by 25% - The Prostate Cancer Prevention Trial) examined the issue of a small, apparent increase of 1% in high grade disease (high Gleason grade disease -- not good) among those on finasteride. Their conclusion was a happy one: in essence, more higher grades were seen because finasteride improves the accuracy of detecting prostate cancer of all grades, including high grade.

The real fresh significance of the just published D'Amico article is not that men and their doctors need to allow for the effects of finasteride (also known as Propecia, or Proscar in the higher dose used to treat enlarged prostates, and off-label for prostate cancer); that was already known, but is well worth repeating and continually emphasizing. The real significance is that Dr. D'Amico agrees with the first group of doctors that finasteride improves detection of prostate cancer and does not increase high-grade disease. You can see that if you check the abstract of the study, available free at www.pubmed.gov. Just search for "d'amico a [au] AND barry [au] AND 2006 [dp] AND prostate cancer". Here is some key information about the study and a key excerpt from the abstract:

J Urol. 2006 Nov;176(5):2010-2; discussion 2012-3 Prostate cancer prevention and finasteride. D'Amico AV, Barry MJ "... Therefore, despite doubling prostate specific antigen [so it would be comparable to PSA in men not on finasteride] during the first 3 years of the Prostate Cancer Prevention Trial, to have prostate specific antigen exceed 4 ng/ml and have a prostate biopsy recommended men receiving finasteride vs placebo required greater increases in prostate specific antigen, which was shown in the Prostate Cancer Prevention Trial to be associated with high grade disease (p < 0.001). Also, the decrease of the contribution to prostate specific antigen from benign prostatic hyperplasia by finasteride improved the performance characteristics of prostate specific antigen to detect Gleason score 7 or higher prostate cancer. CONCLUSIONS: By decreasing the contribution to prostate specific antigen from benign prostatic hyperplasia finasteride makes changes in prostate specific antigen more cancer specific. This effect may explain the increased detection of high grade prostate cancer in men randomized to finasteride in the Prostate Cancer Prevention Trial. ..."

I think I've got a firm grip on what is being said and can spell it out in greater detail if you wish. It's tricky, and it's easy to lose the thread of the reasoning if you don't know the territory. What's going on is complex, but with a lot of study it now appears clear, at least to those who are thinking hard about this. That is wonderful, because those doctors who have kept up with this development are now putting this new knowledge to work, to the great benefit of patients. Sadly, many of us will be consulting doctors who are not up to speed on this development.

If anyone wants more detail, first check a layman's explanation I wrote about the first breakthrough analysis; that analysis was published in the Journal of the National Cancer Institute in August. You can find it at www.mycancerplace.com in the Forum area under the hormonal therapy topic. Or just fire away in a comment below.

Jim Waldenfels (website: http://www.mycancerplace.com/profile.php?id=147)

Posted at 7:11PM on Dec 7th 2006 by Jim Waldenfels

3. Though also medicines and sometimes dangerous..., but nevertheless they often gain us...

Posted at 7:37AM on Dec 8th 2006 by Jon