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Use of Finasteride and Prostate Cancer–Specific Mortality

By: Susan Reckling
Posted: Wednesday, February 6, 2019

Based on 18 years of follow-up of the Prostate Cancer Prevention Trial, the use of finasteride did not increase the risk of death from prostate cancer. In fact, in a letter to the editor published in The New England Journal of Medicine, Goodman et al, of Fred Hutchinson Cancer Research Center, Seattle, reported that the drug commonly used in the treatment of symptomatic benign prostatic hyperplasia was associated with a nonsignificant reduction in the risk for prostate cancer–specific mortality.

“The early concerns regarding an association between finasteride and an increased risk of high-grade prostate cancer have not been borne out,” the authors stated.

The long-term analysis included 296,842 person-years of follow-up. A total of 3,048 deaths (including 42 attributed to prostate cancer) occurred in the 9,423 men who received finasteride, compared with 2,979 deaths (including 56 attributed to prostate cancer) in the 9,457 in the placebo group. The 18-year rate of prostate cancer–specific mortality was 0.43% with finasteride versus 0.60% without (hazard ratio for cancer-specific mortality = 0.75).

In addition, the authors revealed the Gleason scores at diagnosis for men who died of prostate cancer. In the finasteride treatment group, the Gleason scores at diagnosis were ≤ 6 for 7 patients, 7 for 5 patients, 8 to 10 for 13 patients, and unknown for 17 patients. In the placebo group, the Gleason scores at diagnosis were ≤ 6 for 16 patients, 7 for 9 patients, 8 to 10 for 11 patients, and unknown for 20 patients.

Disclosure: The study authors’ full disclosures may be found at nejm.org.



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