WASHINGTON - For the first time, leading medical groups are advising millions of healthy men who are regularly screened for prostate cancer to consider taking a drug to prevent the disease.
The advice stops short of saying men should take the drug finasteride, which is sold in generic form and as Proscar. It is a type of drug called a 5-alpha reductase inhibitor and is available generically to treat urinary problems caused by enlargement of the prostate.
Merck and Co. sells it, at a lower dose, as the baldness remedy Propecia.
However, it has not been widely prescribed as a cancer preventive, and it may carry some risks. The new guidance tells men to talk to their doctors and decide for themselves if the good outweighs the bad.
This advice is bound to be confusing, doctors admit. For one thing, it does not apply to men who choose not to have screening with PSA blood tests.
In men who are regularly screened, finasteride can cut the odds of developing prostate cancer about 25 percent.
"If a man is interested enough in being screened, then at least he ought to have the benefits of a discussion" about taking the drug, said Dr. Barnett Kramer, a
National Institutes of Health scientist and one of the authors of the new guidelines.
They were published in two medical journals and discussed in a news briefing yesterday in connection with a cancer conference in Florida.
They were written by doctors with the American Society of Clinical Oncology and the American Urological Association.
Cost could be a big issue for many men. Finasteride, which must be taken daily, costs $2 to $3 a pill. Insurers may not cover it for cancer prevention.
"There probably would be millions of different attitudes about taking a pill a day to prevent a condition that may or may not occur," said Dr. Howard Sandler of Cedars-Sinai Medical Center in Los Angeles.
Prostate cancer is the second most commonly diagnosed cancer in men worldwide and kills about 254,000 a year.
About 186,000 American men this year will be told they have cancer of the prostate. The disease often is diagnosed from a biopsy after a PSA blood test indicates a high level of a protein. PSA can be high for many reasons, and there is no proof that screening saves lives - the reason no major cancer groups recommend it.
Most men over 55 get the test anyway, then face a dilemma if cancer is found. It usually grows so slowly it is not life-threatening, but it can prove fatal. Treatments often cause sexual or bladder-control problems.
"We still don't know if screening and aggressive treatment is a good thing," but if men are getting PSA tests, taking finasteride is reasonable, said the American Cancer Society's chief medical officer, Dr. Otis Brawley.
Finasteride shrinks the prostate and curbs testosterone, a hormone that helps cancer grow.
A similar drug, dutasteride, sold as Avodart, is being tested to see if it too prevents prostate cancer.