I also echo the same sentiments on the success and continued health of your father.
Just as a point of information to those with the misconception that finasteride can contribute to high grade prostate cancer, the newest data refutes the conclusions of the 2003 study.
http://www.mskcc.org/mskcc/html/86364.cfm
Studies Support Use of Prostate Cancer Prevention Drug
Recent research revealed that the drug finasteride, commonly used to treat enlarged prostates, decreases the risk of prostate cancer by nearly 25 percent. When the original results of the study, known as the Prostate Cancer Prevention Trial, were initially released in 2003, the good news was tempered by the fact that the study also revealed a small but statistically significant increase in the number of aggressive, high-grade prostate tumors in the men from the study who were taking finasteride. But two new analyses of the study's data show that finasteride decreases the risk of all types of prostate cancer, even for those men with high-grade tumors.
Prostate Cancer Prevention Trial
Sponsored by the National Cancer Institute, the Prostate Cancer Prevention Trial (PCPT) was designed to determine if finasteride could prevent prostate cancer in older men. Available in both brand-name and generic forms, finasteride works by blocking the conversion of the hormone testosterone to dihydrotestosterone, a hormone that fuels the growth of all prostate cancers. The drug was developed to treat benign prostatic hyperplasia (BPH), a condition affecting older men in which the prostate enlarges, making urination difficult. Begun in 1993, the randomized, multicenter study followed approximately 19,000 men aged 55 and older, half taking finasteride pills on a daily basis, the other half taking a placebo. Neither the study participants nor their physicians knew who was taking finasteride or the inactive placebo.
The study was halted early in March 2003 when it was determined through the use of annual PSA screenings and digital rectal exams that men taking finasteride were 25 percent less likely to develop prostate cancers than men taking placebos. The results were as follows: 18 percent of men taking finasteride developed prostate cancer versus 24 percent of men taking placebo.
Troubling High-Grade Tumor Results
A note of discord was introduced, however, when it was determined that while finasteride reduced the overall risk of prostate cancer, it also appeared to cause a slight increase in the incidence of the high-grade forms of the disease, which are defined as tumors with Gleason scores of 7 to 10. (The Gleason grading system characterizes the aggressiveness of prostate cancer, providing an estimate of the cancer's potential to grow and spread to other parts of the body, where it is more difficult to treat successfully.) The increase in high-grade tumors -- 6.4 percent of the men in the finasteride group versus 5.1 percent of the men taking placebo -- was considered small but significant.
As a result, few physicians recommended using finasteride as a prostate cancer prevention drug, basing this decision on the belief that the drug was preventing harmless prostate cancers that would never require treatment while potentially encouraging the deadlier versions. Still, the study's researchers wondered if the increased number of high-grade tumors was due to the fact that finasteride was shrinking the prostate, making it easier for doctors to find aggressive, high-grade tumors during needle biopsies.
"These important studies put to rest our original concerns that finasteride could cause more harm than good."
-- Peter Scardino, MD, Chair, Department of Surgery
New Studies, New Thinking
In the years following the PCPT, two separate studies conducted by investigators both inside and outside that trial have sought to clarify the issue. The results from both were published in the May issue of Cancer Prevention Research.
The studies analyzed 500 pathology samples that were removed during prostatectomy from the more than 2,000 patients in the PCPT diagnosed with prostate cancer. (The majority of patients in the study diagnosed with any grade of prostate cancer opted to have the cancer surgically removed, in a procedure called a prostatectomy. This allowed pathologists to compare the "true rate" of high-grade tumors, compared with the grade assigned through biopsy at original diagnosis.) Both studies found that those men in the PCPT who received finasteride had no overall increase in high-grade disease. Among those men treated for the full seven years of the study, the investigators found no significant difference in results: 92 men in the finasteride group developed high-grade tumors compared with 89 men in the placebo group.
"These important studies put to rest our original concerns that finasteride could cause more harm than good," says Peter Scardino, Chair of the Department of Surgery at Memorial Sloan-Kettering Cancer Center and a surgeon specializing in prostate cancer. "We were delighted to see such convincing confirmation that prostate cancer can be prevented safely."
The Food and Drug Administration has yet to approve the use of finasteride for prostate cancer prevention. However, doctors can prescribe drugs for off-label use when appropriate. Men interested in considering the use of finasteride as a prostate cancer preventative should discuss the issue with their physician.
Dr. Scardino advises that men over the age of 50 who are at increased risk of prostate cancer -- African-American men, those with a family history of the disease, or those with an elevated PSA test but a negative biopsy -- should consider taking finasteride or a related drug after discussing the risks and benefits with their physician.