Dr Thompson on 5-ARIs for Active Surveillance in Prostate Cancer

“It dramatically reduces a man’s risk of ultimately needing operations for prostate enlargement...which also come with substantial toxicity, and actually are more prevalent than prostate cancer."

Ian M. Thompson Jr, MD, a urologist at Christus Health, discussed the risks and benefits of the 5-alpha reductase inhibitor finasteride (Proscar) in men with prostate enlargement and those on active surveillance for prostate cancer.

The use of finasteride is associated with several important clinical benefits, although these must be considered alongside its potential adverse effects (AEs). One of the most commonly discussed AEs is gynecomastia, which can occur in men receiving the medication, Thomspon began. Although some cases of gynecomastia were also observed among patients receiving placebo during the Prostate Cancer Prevention trial, the incidence was higher in those treated with finasteride, he noted. However, the overall absolute risk remained relatively low, suggesting that the AE is uncommon and should be weighed against the drug’s broader therapeutic benefits, he continued.

A primary advantage of finasteride is its ability to reduce the risk of prostate cancer and, among men undergoing active surveillance, decrease the likelihood of disease progression or the subsequent identification of tumors requiring definitive treatment, Thompson emphasized. By lowering the risk of progression in low-risk cases, finasteride may help support active surveillance strategies and reduce the need for more aggressive interventions in appropriately selected patients, he added.

Beyond its role in prostate cancer management, finasteride provides several well-established urologic benefits, Thompson noted. The agent improves lower urinary tract symptoms associated with benign prostatic enlargement, including urinary frequency, nocturia, and decreased urinary stream, he explained. Long-term treatment also substantially reduces the likelihood that patients will require surgical procedures for benign prostatic hyperplasia, such as transurethral resection of the prostate (TURP), he said.

Finasteride has also been shown to decrease the risk of urinary retention and urinary tract infections, both of which become increasingly common as men age, Thomspon said. These additional benefits contribute to improved urinary function and may enhance overall quality of life for many patients, he concluded.