PCa patients can benefit from 5-alpha-reductase Inhibitors.

[pjoshea13]

New meta-analysis below [1].

{Dutasteride was approved by the FDA for BPH in November 2001. It has not been approved for PCa in the US. The doctor who wrote my script said 'good luck getting insurance to pay for it', but I have never had a problem.}

"A total of 2,277 patients from 10 studies were included. No significant difference was found in prostate-specific antigen progression between two groups {5ARI and control} (OR = 0.82 ...). However, 5ARI treatment significantly reduced the total progression of PCa (OR = 0.61 ...), especially for patients with local (OR = 0.56 ...) and low-Gleason score (≤7) PCa (OR = 0.63 ...). Additionally, 5ARIs also significantly prolonged the progression-free survival time (HR = 0.57 ...) for PCa patients. No significant difference was found in the occurrence of PCa recurrence, metastasis, biopsy reclassification, and side-effects between two groups."

"Conclusions: Our study suggests that 5ARI treatment can benefit patients with local and low Gleason score (≤7) PCa, especially in delaying the disease progression. More studies with larger sample size and comprehensive study design are still needed to verify our outcomes."

It used to be that ADT-refractory PCa was described as being "androgen independent". The term CRPC first appears in PubMed in 2006, about the time when it was realized that the androgen receptor [AR] remained in play after ADT failed. Hence the continued interest in the AR axis, & the development of Abiraterone [Zytiga] & Enzalutamide [Xtandi].

The ultimate targets of AR axis-based therapy are DHT access to the AR, & AR translocation to the nucleus of the cell. It is therefore plausible that a 5ARI might have a useful role. However, for men on ADT (classic or enhanced), the real benefit of a 5ARI begins as the cancer cells begin to make DHT via alternative pathways.

IMO, the new study was limited in having insufficient data to demonstrate a benefit. I will continue to use Avodart. I view it as a 'safety play'.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/325...

PeerJ

. 2020 Jun 1;8:e9282. doi: 10.7717/peerj.9282. eCollection 2020.

Prostate Cancer Patients Can Benefit From 5-alpha-reductase Inhibitor Treatment: A Meta-Analysis

Tuo Deng # 1 , Xueming Lin # 2 , Xiaolu Duan 1 , Zihao He 1 , Zhijian Zhao 1 , Guohua Zeng 1

Affiliations collapse

Affiliations

1 Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

2 Department of Urology, First Hospital of Shanxi Medical University, Taiyuan, China.

# Contributed equally.

PMID: 32547884 PMCID: PMC7271889 DOI: 10.7717/peerj.9282

Abstract

Background: The efficacy and safety of 5α-reductase inhibitors (5ARIs) in treating prostate cancer (PCa) have not been fully determined. We performed a meta-analysis to evaluate the effectiveness and safety of 5ARIs for PCa patients.

Methods: A comprehensive literature search of online databases was conducted to obtain comparative studies exploring the effectiveness and safety of 5ARIs in treating PCa up to October 2019. Summarized odds ratio s (OR s) or hazard ratio s (HR s) were calculated to compare the outcomes between 5ARI and control groups. Our meta-analysis was registered in PROSPERO under number CRD42018109809.

Results: A total of 2,277 patients from 10 studies were included. No significant difference was found in prostate-specific antigen progression between two groups (OR = 0.82, 95% CI [0.52-1.29], P = 0.40). However, 5ARI treatment significantly reduced the total progression of PCa (OR = 0.61, 95% CI [0.48-0.77], P < 0.0001), especially for patients with local (OR = 0.56, 95% CI [0.44-0.73], P < 0.00001) and low-Gleason score (≤7) PCa (OR = 0.63, 95% CI [0.48-0.84], P = 0.002). Additionally, 5ARIs also significantly prolonged the progression-free survival time (HR = 0.57, 95% CI [0.34-0.96], P = 0.04) for PCa patients. No significant difference was found in the occurrence of PCa recurrence, metastasis, biopsy reclassification, and side-effects between two groups.

Conclusions: Our study suggests that 5ARI treatment can benefit patients with local and low Gleason score (≤7) PCa, especially in delaying the disease progression. More studies with larger sample size and comprehensive study design are still needed to verify our outcomes.

Keywords: 5α-Reductase inhibitors; Meta-analysis; Prostate cancer; Treatment effect.

© 2020 Deng et al.

[Hidden]

Warning-Warning-Warning: "You are treating your PSA not PCa" (Just pulling your leg face here)

Full disclosure: I take Avoradt and over and above it Saw Palmetto.

[LearnAll]

This 5-ARI (finasteride, Dutasteride) issue has been illusive. There are so many contradicting studies. No clarity.

Just last week, Dr Larry Klotz in history of intermittent ADT, wrote that Dutasteride is not effective in off period of IADT. He was the same researcher who was promoting Finasteride many years ago. AVIAS trial concluded that there is no benefit of Dutasteride during off period of IADT.

Can someone give a final answer to this question of Dutasteride use ?

[pjoshea13 in reply to LearnAll]

As I mentioned in my post, for men on ADT a 5ARI is useful when the cancer is close to finding a back door way to produce DHT.

For IADT, I would like to see a study of men receiving T during the off-phase. After all, in the months that they continue to be castrate, DHT is not likely to be a problem.

Do you know if Casodex is effective during the IADT off phase? Same issue.

-Patrick

[LearnAll in reply to pjoshea13]

Return of the T is a very individual phenomenon. About 6% men never see T coming back after stopping a long term ADT.

My T is still very low (only 5) after 6 1/2 month off lupron and PSA stays at 0.2. So I donot feel like adding anything until I see movement in PSA beyond 4.

I am doing well and my hotflashes and tiredness is already less..probably placebo effect.

Presently I am only taking herbs, spices, roots and leaves plus Metformin, atorvastatin, Doxycycline. Eager to see how it all unfolds in next few months.

I do not have courage to add Testosterone yet. My DHT is also very low.

[pjoshea13 in reply to LearnAll]

Good luck with your regimen.

[Graham49]

Yes there was not enough data to make conclusions except for local PCa and low Gleason score.

Of the 2,277 PCa patients involved in the analysis , 1967 had local PCa. 694 patients were allocated to the 5ARIs and 1583 to the control group.

The Therapies that PCa patients received prior to recruitments included RP, RT, AS or no treatments.