THERAPEUTIC HOTLINE: Treatment of androgenic alopecia with finasteride may result in a high grade prostate cancer in patients: fact or fiction?

Abstract

Finasteride at a dose of 1 mg (Propecia®) has been used for the treatment of androgenic alopecia in men. Though finasteride has been successfully used, there is ongoing controversy surrounding its use since the publication of the Prostate Cancer Prevention Trial (PCPT) which includes claims of increased risk for higher grade prostate cancers. This has produced confusion on consulting and treatment of patients interested in starting finasteride for androgenic alopecia. We felt there was a need to clarify further the results of PCPT for our readers and help understanding the real risk of prostate cancer development of patients on finasteride. In conclusion, we suggest the guidelines for treatment monitoring for patients on finasteride which based on comprehensive review of the trial presents safe treatment for androgenetic alopecia without the concern for the induction of high-grade prostate cancer.

Side Effects of 5‐Alpha Reductase Inhibitors: A Comprehensive Review

“…Findings demonstrated an overall reduction of prostate cancer by 24.6% in the treatment arm, with an increased rate of development of Gleason 7–10 prostate cancers (37% treatment, 22.2% placebo). Subsequent reanalyses by several authors suggested multiple counterarguments against the increased risk for HGPC, including lack of reliability of Gleason scoring following 5ARI treatment, reduction in prostate volume and subsequent increased detection of malignancy, and increased sensitivity of prostate specific antigen (PSA) as a prostate cancer detection marker in the finasteride group, among others .…”

Androgenetic Alopecia: Therapy Update

“…Some patients may have persistent sexual side effects for at least 3 months despite cessation of the drug, which may lead to increased rates of depression and suicidal thoughts [ 30 ]. In regards to concerns about prostate cancer as a side effect of 5-alpha-reductase inhibitors, a recent meta-analysis showed that finasteride does not increase the risk of developing high-grade prostate cancer [ 31 ]. For a 30 day supply of finasteride 1 mg tablets, the average retail price is $78 USD [ 16 ].…”