Here is a library of 20 papers about using Dutasteride to treat prostate cancer.
In one study, Dutasteride monotherapy reduces PSA by 50%, reduces prostate volume by 25%, and reduces tumor volume by 30%, after 6 months of treatment, compared to placebo (Moore, 2017).
On that subject, FYI, I recently was perusing the 2024 NCCN guidelines.....you might check out the section on uses of ADT for PCa....the ides are mentioned!
Maybe we should put up a website for this....where we can add everything useful for PCa...starting from 3 main categories: SOC, clinical trials, in-vivo and in-vitro....
That is true in the USA, not true in the UK (no black box warning).
Here is a slide comparing the reported increased rate of aggressive prostate cancer to placebo for Finesteride (not Dutasteride). It's a very small increase, and likely not statistically relevant. After Thompson published his paper in 2003, many follow-on papers have debunked this result. Recent studies have found no such association with Dutasteride, the improved version of Finesteride.
Black Label Warning on Dutasteride:
There is currently a black box warning on Dutasteride (0.5 mg/day), because one study from 2003 reported a small increase in the risk of having high-grade prostate cancer (i.e., large tumors).
I have two papers (there are likely more out there) that debunk this report. They call for a removal of the warning label.
There are two different biases that caused the higher incidence of high-grade tumors.
One is a “detection bias”, that relates to the fact that Dutasteride shrinks the prostate’s volume by 25%. So, the probability of a biopsy needle increases as the size of the prostate decreases, assuming that the number of tumors remain the same. One of the papers (Cohen, 2007) did a calculation of how much the probability of hitting a large tumor (high-grade tumor) increases when the prostate shrinks, and the calculation predicted the same amount of increase in the incidence of high-grade tumors in men on Dutasteride.
The other bias is a “diagnosis bias”. In a large study of Veterans at VA hospitals, they also found an increased risk of higher-grade PCa for men taking Dutasteride. The explanation for the increased rate of larger tumor detection is related to the fact that the PSA drops by about 50% (or more) after a few months of being on Dutasteride. For some men, the PSA dropped below the screening threshold for getting a biopsy (e.g., PSA = 4). So, those men decided to not get a biopsy. But, some of those men eventually got PCa later on (as their PSA continued to rise, even on Dutasteride.) The fact that these men weren’t screened (because of their low PSA values), meant that they eventually ended up with higher-grade (larger) tumors, compared to men who received early screening. The paper by Sarkar (2019) explains this “diagnosis bias”.
Both types of biases explain why the black box warning was originally applied. But, the effect has since been debunked because of both the detection bias and the diagnosis bias.
Recent studies with large numbers of men support that Dutasteride reduces prostate cancer rates across all risk groups. These are:
ARIA (2004) N=4325 51% reduction in PCa;
REDUCE (2010) N=8231 23% reduction in PCa;
CombAT (2011) N=4844 40% reduction in PCa.
The average reduction in PCa is 38%.
The single best paper on Dutasteride effect on PCa is a meta-analysis by Monga (2013).
I've mentioned this before but I had to swear off finasteride. The dental problems it caused were no fun. That was too high a price to have PSA reduced by half, which it did do. I am not inclined to try Dutasteride either. With the same mechanism of action I would expect the same problem.
I asked ChatGPT for information about Dutasteride and dental problems, and this is what it said:
"There isn't significant evidence to suggest that Dutasteride, a medication primarily used to treat benign prostatic hyperplasia (BPH) and androgenic alopecia (male pattern hair loss), directly causes dental problems. Dutasteride works by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), a hormone associated with prostate enlargement and hair loss.
However, like many medications, Dutasteride may have side effects, but dental problems are not commonly listed among them. Some potential side effects of Dutasteride include decreased libido, erectile dysfunction, breast tenderness or enlargement, and decreased ejaculate volume.
If you are experiencing dental problems while taking Dutasteride, it's essential to consult with your healthcare provider to determine the cause and appropriate management. It's also crucial to maintain good oral hygiene practices regardless of any medications you may be taking."
Were you taking a bisphosphanate for osteoporosis at the same time? That is known to cause serious dental problems in a small fraction of men.
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