I get this question from a lot of men that have prostate cancer.
Although the black label warning is a concern to some doctors, and has been discussed here in previous posts, I think the main reason is simply that most doctors don't know about it.
Here is the single best paper reviewing the three major trials that compared Dutasteride to placebo for men with PCa. They draw the conclusions that:
"While the analysis had several limitations, the results showed that dutasteride reduced the risk of detectable prostate cancer, including low-grade prostate cancers, which are less likely to lead to death. Additionally, in our analysis, there was no increased risk of detectable high-grade prostate tumours, defined by Gleason ≥7 scores, as shown in CombAT and REDUCE [trials]."
The question of why doctors don't prescribe Dutasteride more often is indeed interesting. I've also heard this from many men with prostate cancer.
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One of the reasons might be the black label warning. However, I think the main reason is simply that most doctors are not well-informed about this medication or its benefits.
The paper you referenced does provide a solid review of the three major trials comparing Dutasteride to placebo in men with prostate cancer.
This is indeed a significant finding. Given that Dutasteride can reduce the risk of detecting low-grade prostate cancer without increasing the risk of high-grade cancer, it deserves more attention from the medical community.
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