This post is in reference to an increased prostate cancer risk from finasteride and dutasteride (see here).
E. Antonio Mangubat, MD wrote an interesting metaphor to help some of his patients and colleagues understand the many discussions on cancer risks in association with taking finasteride. He writes:
“It is sad that the number of lives saved [who have not developed prostate cancer] has been discounted because of the words used …. [in the opinions drawn].
In my opinion their conclusion [New England Journal of Medicine] is like saying seat belts should not be used because it increases the chances of dying if the car ignites on fire. While the caution is true, the conclusion ignores the lives saved if the car does not incinerate.”
We both agree that the conclusions in this NEJM article introduce a fear factor that people with hair loss will now have to consider cancer risks and even death from prostate cancer if they choose to take this drug. The study that is referenced was performed on 20,000+ men over 55 years old in a classic double blind methodology and it showed that the cancer risk was reduced by 25% for those men who took the drug when compared to the control group.
The fear was generated from the observations that there was a higher risk of high grade tumors in those men who took the drug, but there was no study of death rates on the men with higher grade tumors despite the high numbers of men studied. For those readers who are still confused, the pathologists who reviewed the ‘slides’ of the tumors felt that the tumors looked ‘meaner’ (my words), but if these meaner tumors did not kill the men who had that diagnosis made, then it seems almost meaningless, an exercise of intellectualization.
I am angry about these conclusions to two reasons: (1) I must notify patients of these recommendations since they come from the FDA and the NEJM journal, because this has now become the standard of care, and (2) patients who are balding and could be helped with a simple daily finasteride pill may be frightened into the hair transplant surgery route. Yes, I would make money from the transplant, but I prefer that patients simply take a pill rather than have surgery that could perhaps otherwise be avoided.