Nalakrats & I believe there is a role for a 5-alpha reductase inhibitor in advanced PCa. Some disagree. I would be remiss if I didn't point out that long-term use (as with all PCa drugs) has a downside:
"This treatment may result in development of non-alcoholic fatty liver diseases (NAFLD), insulin resistance (IR), type 2 diabetes (T2DM), dry eye disease, potential kidney dysfunction, among other metabolic dysfunctions."
When my prostatectomy failed 16 years ago, I wasn't concerned that salvage radiation increased the risk of other cancers. Those risks were not apparent for 5 years. I was starting to think short term.
For those taking the long view, this paper may be of interest.
Incidentally, Avodart has a long half-life. Taking a vacation from the drug isn't so easy.
Health Risks Associated With Long-Term Finasteride and Dutasteride Use: It's Time to Sound the Alarm
Abdulmaged M Traish 1
Affiliations collapse
Affiliation
1 Department of Urology, Boston University School of Medicine, Boston, MA, USA. atraish@bu.edu.
PMID: 32202088 DOI: 10.5534/wjmh.200012
Abstract
5α-dihydrotestosterone (5α-DHT) is the most potent natural androgen. 5α-DHT elicits a multitude of physiological actions, in a host of tissues, including prostate, seminal vesicles, hair follicles, skin, kidney, and lacrimal and meibomian glands. However, the physiological role of 5α-DHT in human physiology, remains questionable and, at best, poorly appreciated. Recent emerging literature supports a role for 5α-DHT in the physiological function of liver, pancreatic b-cell function and survival, ocular function and prevention of dry eye disease and kidney physiological function. Thus, inhibition of 5α-reductases with finasteride or dutasteride to reduce 5α-DHT biosynthesis in the course of treatment of benign prostatic hyperplasia (BPH) or male pattern hair loss, known as androgenetic alopecia (AGA) my induces a novel form of tissue specific androgen deficiency and contributes to a host of pathophysiological conditions, that are yet to be fully recognized. Here, we advance the concept that blockade of 5α-reductases by finasteride or dutasteride in a mechanism-based, irreversible, inhabitation of 5α-DHT biosynthesis results in a novel state of androgen deficiency, independent of circulating testosterone levels. Finasteride and dutasteride are frequently prescribed for long-term treatment of lower urinary tract symptoms in men with BPH and in men with AGA. This treatment may result in development of non-alcoholic fatty liver diseases (NAFLD), insulin resistance (IR), type 2 diabetes (T2DM), dry eye disease, potential kidney dysfunction, among other metabolic dysfunctions. We suggest that long-term use of finasteride and dutasteride may be associated with health risks including NAFLD, IR, T2DM, dry eye disease and potential kidney disease.
"This treatment may result in development of non-alcoholic fatty liver diseases (NAFLD), insulin resistance (IR), type 2 diabetes (T2DM), dry eye disease, potential kidney dysfunction, among other metabolic dysfunctions."
Wow, I was using it for a long time before Sartor took me off of it.
Thanks. Just when I think I'm doing the right thing by taking Avodart to lower DHT, I read that there may be some serious long-term consequences. I suppose we have to weigh the risks... but it's never a simple answer. Ugh.
"Here, we advance the concept that blockade of 5α-reductases by finasteride or dutasteride in a mechanism-based, irreversible, inhabitation of 5α-DHT biosynthesis results in a novel state of androgen deficiency, independent of circulating testosterone levels."
Seems like many of these long-term side-effects can be offset by a healthy diet and exercise and there is a lot of cross over with general ADT side effects. Those who chose to go for the benefit of 5a-reductase inhibitors should be mindful to increase their benefit/risk ratio by choosing a lifestyle that is associated with health metabolism and by checking glucose, insulin, kidney markers, and lipids regularly.
Maybe there is a point at which one should take a long break. I think of 5+ years as very long term in our demographic. I have been on it much longer than that but I will continue for now. I'm not aware of any issues. I tend to blame everything on the absence of testosterone..
Anecdotal, of course, but on finasteride for five years with no bad side effects.
How long have you been using the Avodart, Nal? I was going to pitch it to my oncologist as an add-on to a proposed Eligard-Apalutamide combo (in the works in a couple of weeks). ADT3 and then some chemo might slow the cancer down a wee bit.
Me too..I had been a Finasteride user for around 8 years, daily. As I noticed my libido slowly vanishing, I decided to radically stop it..Soon after, I noticed my sperm volume decrease really a lot to less than half, but Dr. Urologist stated would be fully normal for men in the early 50s..But then, around 2 years later, came a psa of 9.3 and Pca diagnosis...
1mg, only..But one never knows.. If a friend would ask me today about hormonal medications just for hair loss issues..I'd surely answer with a loud , No...keepdistance!!
I have been using Avodart ( one capsule every 3 days ) since 2016 even after stopping all my other treatments. I was diagnosed in 2015 for GS9 PCa. Treated with RP + IMRT + ADT ( 2 Yrs ) and my PSA after treatment remaining at 0.008ng/ml throughout up to now. Some says in my situation continuing with Avodart is of no use. My preference to continue was only the"Dr.Myers" factor. Since of late I have developed NAFLD and dry eyes for no conceivable reasons. I think I have to give serious thoughts to the facts disclosed in your text and stop taking Avodart.
Patrick, will it not be a wiser decision?
Thank you for giving us the updated information as you usually do.
Well, NAFLD, which is a silent epidemic in the U.S., is not to be messed with IMO. & any eye condition that can be avoided. I would take a break from Avodart. It would have to be a long break, considering the lengthy half-life.
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