Dutasteride (5-ARI) extends time to disease progression in Low-Risk men on Active Surveillance, compared to Placebo

[janebob99]

This study by Finelli et al. (2010) looks at the effect of Dutasteride (5-ARI) on the rate of prostate cancer disease progression in Low-Risk men on Active Surveillance. The use of a 5-ARI was associated with a significantly lower rate of pathologic disease progression and lower rate of abandonment of active surveillance. 19% of men in the Dutasteride group experienced pathologic disease progression, compared to 37% in the placebo group, after 38 months. (p = 0.001).

pubmed.ncbi.nlm.nih.gov/212...

[witantric]

How much is the PSA drop because the size of the prostate gets smaller?

[janebob99 in reply to witantric]

That's a good question. I don't think anyone has reported what fraction of the total PSA drop is attributed to shrinkage of the prostate versus shrinkage of the tumor(s). We know that the prostate shrinks by 25% and the tumor shrinks by 30%, so the PSA split may be 60/40 or 50/50. However, tumors are more dense than healthy prostate tissue, so they may produce proportionately more PSA than healthy prostate tissue. So, the split could be 70/30 or 80/20.

[dhccpa]

Have you talked to your MO about using dutasteride? The info you post looks interesting. I assume it's cheap but much resisted among oncologists for use in PCa.

[janebob99 in reply to dhccpa]

My MO doesn't know anything about Dutasteride. She's young (~35), and I don't think they teach 5-alpha reductase inhibitors in medical school anymore.

My PCP did prescribe Dutasteride for me, because my DHT was unusually high.

I read recently that Prostate Cancer increases the amount of 5-alpha reductase enzyme, which, in turn, causes higher levels of DHT.

My PSA has dropped 76%, from10 to 2.4 over the past 4 months on Dutasteride monotherapy (no ADT or RT or RP). So, it's a real thing.

Unfortunately, about 30% of men with PCa don't respond to Dutasteride, so that may be why it's not prescribed more often. But, 70% of men do respond, which is good odds.

Bob

[dhccpa in reply to janebob99]

Thanks. I was reading about natural substances that reduce 5-alpha reductase, although probably weakly.

[NanoMRI]

Nine years since my diagnosis, initially G 3+3, and I am still puzzled by the oxymoron progression of 'low-risk' prostate cancer. All the best to all of us trying to find our best path to beating this beast.

[j-o-h-n in reply to NanoMRI]

Unfortunately, our best path is in the shape of a greyhound race track....and we're the mechanical "Rusty" rabbit.

Good Luck, Good Health and Good Humor.

j-o-h-n

[NanoMRI in reply to j-o-h-n]

Appreciate the humor. The track has not appealed to me which is why I strive to keep of the most common track, named standard of care.