From the FDA Drug Label
- 2 Increased Risk of High-Grade Prostate Cancer Men aged 55 and over with a normal digital rectal examination and PSA ≤3.0 ng/mL at baseline taking finasteride 5 mg/day in the 7-year Prostate Cancer Prevention Trial (PCPT) had an increased risk of Gleason score 8 to 10 prostate cancer (finasteride 1.8% vs placebo 1.1%).
The use of finasteride in patients with a normal PSA level may increase the risk of high-grade prostate cancer. Therefore, finasteride is not necessarily beneficial for patients with a normal PSA level, as it may pose a risk of developing more aggressive prostate cancer 1.
- Key points:
- Increased risk of high-grade prostate cancer in men aged 55 and over with normal PSA levels
- Finasteride may not be beneficial for patients with normal PSA levels due to the potential increased risk of aggressive prostate cancer.
From the Research
Finasteride is not typically recommended for patients with normal PSA levels unless they have male pattern baldness or benign prostatic hyperplasia (BPH). For male pattern baldness, the standard dose is 1mg daily, while for BPH, it's 5mg daily (marketed as Proscar) 2. Finasteride works by inhibiting the enzyme 5-alpha reductase, which converts testosterone to dihydrotestosterone (DHT), a hormone that contributes to hair loss and prostate enlargement.
Some key points to consider when prescribing finasteride include:
- The potential benefits of finasteride in reducing the risk of BPH progression, such as acute urinary retention and surgical intervention 2
- The potential side effects of finasteride, including decreased libido, erectile dysfunction, decreased ejaculate volume, and rarely, depression 3
- The need for baseline PSA testing and adjustment of PSA values by a factor of 2 to accurately interpret results for cancer screening purposes 4
It's also important to note that finasteride can lower PSA levels by approximately 50% after 6-12 months of use, which must be considered when interpreting PSA results for prostate cancer screening 4. Additionally, finasteride has been shown to be effective in improving urinary symptoms in patients with BPH, particularly in those with medium to large prostates 2.
Overall, the decision to prescribe finasteride should be based on a careful consideration of the potential benefits and risks, as well as the individual patient's medical history and needs. Finasteride should only be prescribed for patients with normal PSA levels if they have a clear indication for its use, such as male pattern baldness or BPH.