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.

[well-wisher]

Your experience and observations about PSA levels and prostate/tumor shrinkage on Dutasteride are quite insightful. The differentiation in PSA drop due to prostate versus tumor shrinkage is indeed an important consideration. Given that tumors tend to be denser and potentially produce more PSA per unit volume than healthy prostate tissue, the PSA split you mentioned could very well be skewed towards a higher tumor contribution.

Regarding the prescription practices, it's interesting that your MO isn't familiar with Dutasteride. It highlights a potential gap in current medical training or perhaps a focus shift towards newer treatments. It’s great that your PCP recognized the potential benefit of Dutasteride given your high DHT levels.

Your significant PSA drop is a promising result, emphasizing Dutasteride’s efficacy in many cases. The statistic that about 30% of men with PCa don't respond to Dutasteride is a crucial piece of information for setting realistic expectations and understanding its variable effectiveness.

Given the variability in response to Dutasteride, are there specific biomarkers or genetic factors that could predict which patients are more likely to benefit from this treatment? This could help tailor more personalized treatment plans and potentially improve outcomes.

Also, according to my experience, the highest quality Dutasteride works even more effectively, I order it from global-world-delivery.com/c... recommend it to everyone.

[mchale]

Ive been on dutasteride since 2002 for hair loss, was always told that you double the PSA # to get your true PSA

[janebob99]

That's an urban myth. There are no studies that prove that Dutasteride "masks" a true PSA.

What it does do is shrink the prostate, which causes PSA levels to drop by about 50%. It also shrinks the size of known PCa tumors (as measured by MRI scans, compared to placebo).

The reason they came up with the rule to "double your PSA" has to do with PCa screening. Some men who took Dutasteride for baldness found that their PSA dropped below the threshold for screening, and, hence, postponed getting PSA tests. This, in turn, resulted in a higher incidence of PCa in men on Dutasteride. But, that's a detection bias. SO, the doctors decided to artificially "double the PSA" in order to make sure that these men got screened appropriately.