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Dutasteride Reduces Tumor Volume by 30% after 6 months.

janebob99 profile image
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This chart compares prostate cancer tumor volume measured by MRI, at baseline and at 6 months, comparing placebo to Dutasteride. This was a randomized, double-blind, placebo-controlled clinical trial.

The cohort included Low and Intermediate Risk men, GS-6-7, baseline PSA = 6-7, median age 64 y.o, N=42.

The average tumor volume increased by 17% in the placebo group , while the average tumor volume decreased by -31% in the Dutasteride group, over the 6 month period. The difference between these two percentage changes is 48%.

pubmed.ncbi.nlm.nih.gov/278...

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maley2711 profile image
maley2711

That result is more meaningful than the PSA reduction,,,IMHO. Always good to see researchers looking at new uses for inexpensive drugs!!!

dhccpa profile image
dhccpa

In these dutasteride studies, were patients also on ADT?

janebob99 profile image
janebob99 in reply to dhccpa

I went back to the original source document and there is no mention of ADT. The cohort was men on active surveillance, low and intermediate risk.

dhccpa profile image
dhccpa in reply to janebob99

That makes sense. If ADT shuts off T, then there should be no DHT. Is that correct?

Apparently, there are natural DHT blockers, like biotin and zinc.

Xavier10 profile image
Xavier10 in reply to dhccpa

Last time I took a PSA test it had instructions not to take vitamins, specifically listing biotin

dhccpa profile image
dhccpa in reply to Xavier10

Interesting. I've never had those instructions.

Xavier10 profile image
Xavier10 in reply to dhccpa

it might be a general instruction for any lab. I can’t tell for sure.

Text
janebob99 profile image
janebob99 in reply to dhccpa

Yes, DHT is made from T. So, if T goes down, so does DHT. What's neat about Dutasteride is that the DHT is reduced by 95% and the T and E increases by 20%.

dhccpa profile image
dhccpa in reply to janebob99

How about castrate resistance using dutasteride? Is it similar to CR on ADT?

janebob99 profile image
janebob99 in reply to dhccpa

There isn't a lot of data out there about Dutasteride and CRPC.

Here is a plot of PSA drop versus patient ID # after 6 months on Dutasteride. The green arrows indicate people who are non-responders (in my opinion). In the first group of men who don't have PCa, the % of non-responders is about 15%. In the second group, men with PCa, the % of non-responders goes up to about 30-35%, depending on how you count them.

ncbi.nlm.nih.gov/pmc/articl...

Dutasteride Responders
janebob99 profile image
janebob99 in reply to dhccpa

Actually, for castrate-resistant men, I would not expect Dutasteride to have much of an effect on lowering PSA. By definition, being "castrate-resistant" means that lowering T (or DHT) to castrate levels won't have any effect on PCa.

There is a paper by S. Shah that looked at castrate-resistant men, and he concluded that Dutasteride didn't have much of an effect on lowering PSA, except in a few patients.

Dutasteride might be a useful adjunct drug to use with BAT therapy.

Hmmm....I should patent that...

dhccpa profile image
dhccpa in reply to janebob99

OK, that was my thought as well.

Thanks

Gl448 profile image
Gl448

Do any of the studies your researching/graphing give any indication of how many people taking dutasteride get diagnosed with high-grade/aggressive cancers?

janebob99 profile image
janebob99 in reply to Gl448

The short answer to your question is no study has shown an increased risk of high-grade PCa with Dutasteride, that I am aware of. (Perhaps someone can provide a study that contradicts this statement?)

You are referring to the black box warning label on Finasteride, which was applied to Dutasteride in the USA. The UK has no such warning for Dutasteride.

This old warning has since been debunked by many authors. If you send me an email to janebob99@lobo.net, I will send you papers that debunk this warning.

But, I did make a chart showing the raw data from the original paper by Thompson (2003) that was the basis for the black box warning on Finasteride. You can see that there was an increased rate of high-grade prostate cancers after 7 years of (6%) for Finasteride versus Placebo (5%) (N=4368). That's an absolute difference of 1% between Finasteride and Placebo. You can review the paper to see the actual numbers of men in this risk category.

Interestingly, Thompson et al. state that their conclusion about high-grade PCa incidence may have a bias error due to the significant shrinkage of the prostate with Finasteride, causing a "bias against any evidence of benefit for finasteride". Shrunken prostates will have a higher probability of detecting high-grade (large) tumors when doing random needle biopsies. That is called a "detection bias" in the literature.

Note: Thompson only studied Finasteride, not Dutasteride.

pubmed.ncbi.nlm.nih.gov/128...

Many recent studies (with large numbers) have been published since 2003 about Dutasteride and PCa, and none of them show an increased risk of high-grade PCa. The average reduction in PCa risk when taking Dutasteride is reported to be 38% [23%-51%].

For an N=1, my own PSA dropped by 76%, from 10.0 to 2.44, after 4 months on Dutasteride monotherapy (no ADT). That makes sense, because Dutasteride reduces DHT by 95% (DHT is the primary form of testosterone that binds to Androgen Receptors on PCa cells).

MRI measurements of tumor volume (Moore (2017)) have shown that pre-existing PCa tumors shrank in size by 30% when taking Dutasteride compared to Placebo (which grew 17% during the same time period), for a net difference of -48%shrinkage between Dutasteride and Placebo. This tumor shrinkage mostly explains why the PSA reduces by 50% (on average) when taking Dutasteride (note: the prostate gland itself shrinks by about 25%, which also reduces PSA).

pubmed.ncbi.nlm.nih.gov/278...

High-Grade prostate cancer risk
Starr15 profile image
Starr15

interesting, but the study only had 46 men.

janebob99 profile image
janebob99 in reply to Starr15

I think that makes my point. Such a small number of men makes the statistics questionable.

But, I think that this result (6% versus 5%) for only 46 mens is the sole basis for slapping the black label warning on Dutasteride.

What do you think?

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