Monday, March 2, 2009

Prostate Cancer, Finasteride, PSA, Part 3

In my last two posts I have talked about how the recommendation by the American Urological Association (AUA) and the American Society of Clinical Oncology that men who get regular prostate cancer screening with the blood test for prostate-specific-antigen (PSA) consider taking the medication finasteride poses a dilemma for men as neither organization has made the recommendation that men get this screening in the first place. Screening with the PSA has not yet conclusively shown to reduce overall mortality rates.

The PSA is not a perfect test. There are a number of false positives which will lead to some unneccesary biopsies and false negatives as well. There is a lot of research trying to come up with a better more specific test but for now it is the best we have. All major cancer organizations recommend that men over 50 talk with their doctors about whether or not to check the PSA but give no further guidelines than that. So what is a man to do?

I am a member of Zero, which is a coalition of prostate cancer education and research advocacy groups which believes that one death from prostate cancer is one death too many. Zero currently focuses it's efforts on attempting to increase research funding, make sure that PSA tests are covered by insurance companies as well as Medicaid programs, and encouraging more widespread prostate cancer screening. I am concerned that Zero may get sidetracked by the finasteride issue. No pharmaceutical except finasteride has ever been recommended for prevention in such a large group of people (which is essentially most middle aged men) and I think this receommendation is premature. We only have one study (albeit a large one) showing it's preventative effects. We don't know though about possible risks and untoward effects associated of so widespread use of finasteride and I believe that more studies need to be done and that current efforts be focused on research for better screening tools, treatments, and education about the need for PSA screening.

In the meantime I think the issue is best summed up by Howard Sandler MD, chair of radiation oncology at Cedars-Sinai Medical Center in Los Angeles. He was the moderator of the press briefing on the finasteride study and was asked directly by a reporter whether or not he will take the drug. His answer - "I haven't made up my mind yet".
Thought for the day
The existence of love is one certainty in life.

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