ONS Connect - October 2008 - (Page 29)

NEwTREaTmENTS,NEwHOpE New Study Makes Case for Prostate Cancer Drug [By Deborah McBride, RN, MSN, CPON ®, Contributing Editor] F or the first time, researchers say that they have a drug that can significantly reduce a man’s risk of developing prostate cancer by 30%. The results arise from a new analysis of a large federal study. The initial results of the trial appeared to have underestimated the benefits and overestimated the potential risks of finasteride, according to a new analysis of data from the study. The results of the initial study of 19,000 participants in the Prostate Cancer Prevention Trial were published in 2003 and showed that men who took 5 mg of finasteride daily for seven years had a 25% reduced risk of developing prostate cancer compared with men taking a placebo. However, the initial analyses of the results indicated that finasteride was associated with a reduction in low-grade cancers that would never spread while causing a small increase in high-grade prostate cancers. As a result, cancer researchers argued that finasteride only prevents indolent cancers that would never require treatment. The new study’s researchers speculated that perhaps as the drug decreased the size of the prostate, aggressive cancer cells were more apparent during a biopsy, exaggerating the risks of taking the drug. In the new study, a pathologist examined 500 of the prostates removed during the initial trial and compared the kinds of cancers found at surgery to those initially diagnosed with a biopsy. The researchers concluded that finasteride decreases the risk of having any tumor at all, large or small, fast or slow growing, by the same amount, nearly 30%. The new results open a debate about whether men should take the drug. Prostate cancer is unlike many cancers because it is relatively slow-growing, and although it can kill, it often is not lethal. In fact, some researchers believe that a major problem is that men are getting screened, discovering they have cancers that may or may not be dangerous, and opting for treatments that can leave them impotent or incontinent. According to the researchers, although 10% of men aged 55 and older are diagnosed with prostate cancer, the cancer is lethal in no more than 25% of them. Taking the drug might not reduce the death rate because so few men die from the disease, but it could prevent the consequences of overtreatment, which is the situation today. The authors of the new study believe that with finasteride as many as 100,000 cases of prostate cancer a year could be prevented. The study did not look for a decline in death rates. Finasteride is available as a generic for about $2 a day, and millions of men already take it to shrink their prostates. It blocks the conversion of testosterone to dihydrotestosterone, a hormone active mostly in the prostate and scalp and that all prostate cancers need to grow. Finasteride is approved by the U.S. Food and Drug Administration for treating benign prostatic hyperplasia symptoms but is not yet approved for prostate cancer prevention. Without that approval, finasteride cannot be advertised as preventing cancer and insurers may not pay for it. The American Urology Association and American Society of Clinical Oncology are in the process of developing guidance on finasteride use for prostate cancer prevention. ✱ Lucia, M.S., Darke, A.K., Goodman, P.J., La Rosa, F.G., Parnes, H.L., Ford, L.G., et al. (2008). Pathologic characteristics of cancers detected in the Prostate Cancer Prevention Trial: Implications for prostate cancer detection and chemoprevention. Cancer Prevention Research, 1, 167–173. Contributing Editor Deborah McBride, RN, MSN, CPON ®, is a nurse at the Kaiser Permanente Oakland Medical Center and a faculty member at Samuel Merritt College in Oakland, CA. OctOber 2008 ONS CONNECT 29

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ONS Connect- October 2008 Contents Editor's Note Just In Up Front You Tell Us Up Close &�Professional Web Connect Five-Minute In-Service Capitol Connection Caregiver Care Straight Talk New Treatments, New Hope Working for You Calendar of Events Staying on Top

ONS Connect - October 2008

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