Is Finesteride an ADT? Should I stop it?

[GranPaSmurf]

I've been on finesteride for years. Is anyone else on Lupron and finesteride both? I'm told it depresses the PSA by half. I don't think that makes sense.

[Tall_Allen]

That's for men who haven't had their prostate treated and have BPH.

[GranPaSmurf in reply to Tall_Allen]

That's what I was when it was prescribed. UO said keep taking it... but he did not seem too sure of it. So... Same question, stop or keep taking it?

[Tall_Allen in reply to GranPaSmurf]

Same question - has your prostate been treated - surgery or radiation?

[GranPaSmurf in reply to Tall_Allen]

Only 2 weeks of Casodex and 2 months of Lupron.

[Tall_Allen in reply to GranPaSmurf]

Then it certainly won't cut your PSA in half. It probably doesn't have any effectiveness at all for you if the Lupron is keeping your testosterone (T) levels very low. It prevents the conversion of T to DHT, which is a much more potent androgen. But if you have hardly any T in the first place, there is probably no additional effect. A randomized trial of intermittent ADT where they continued finasteride during the "vacation" in half the men found that it had no effect on progression. You can ask your MO to stop it and monitor if it changes your PSA.

[GranPaSmurf in reply to Tall_Allen]

Ah ha! I get it... and some direction for research.

[Magnus1964]

Have you been diagnosed with Prostate Cancer or BPH? Every patient responds differently to Lupron and finesteride. The statement that these drugs only reduces PSA by half does not hold and validity.

[pjoshea13]

Finasteride will depress PSA caused by BPH. It does this by inhibiting the conversion of testosterone [T] to dihydrotestosterone [DHT]. Reduction of DHT would also have an inhibitory effect on PCa, although Finasteride is not approved for that purpose.

Lupron will suppress gonadal T production, which should lower DHT dramatically & inhibit PCa - & BPH - and therefore PSA. Most would say that Lupron trumps Finasteride.

However, a small minority of men produce DHT via a pathway that does not involve T. For that reason, those men might benefit from Finasteride added to Lupron.

Dr. Myers always tested DHT levels. He preferred to use Dutasteride, rather than Finasteride when DHT was not sufficiently lowered by ADT.

-Patrick

[GranPaSmurf]

so, it seems like a DHT test, early on, would give a direction as to whether ADT plus Finasteride/Dutasteride might have added efficacy, right?

[MateoBeach]

The ADT (LHRH agonists or antagonists) greatly diminish T from the testes. But do not affect adrenal production of androgens. 5-Alpha-reductase inhibitors (finasteride and dutasteride) will block the conversion of adrenal T to DHT which is much more potent. So this is a theoretic "plus" in androgen deprivation treatment. Dutasteride is much more potent inhibitor of this pathway than finasteride, so it would be preferred. Note that clear evidence of benefit from this in clinical trials is lacking (to my knowledge). So it cannot be strongly advocated. Nevertheless, dutasteride 1.0mg daily is part of my current regimen since being on it with bicalutamide for 4 years with good control. The bicalutamide failed recently, but I am reluctant to stop the dutasteride at this time.

[Sxrxrnr1]

3 month supply Avodart generic dutasteride over 100 dollars thru my Medicare part D, Proscar generic finasteride zero dollars. 400 bucks per year verses nada.