Finasteride chemical structure
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Finasteride

Finasteride is an antiandrogen which acts by inhibiting 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone. It is used in benign prostatic hyperplasia (BPH) in low doses, and in prostate cancer in higher doses. Additionally, it is registered in many countries for male-pattern baldness. Drug trade names include Propecia® and Proscar ® both products of Merck & Co. (the former is marketed for hair loss in male pattern baldness, and the latter for BPH). more...

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The Prostate Cancer Prevention Trial (PCPT) showed at a dosage of 5mg per day, as is commonly prescribed for BPH, though much higher than the 1mg generally prescribed for hair loss, participants taking finasteride were 25% less likely to have developed prostate cancer at the end of the trial compared to those taking a placebo. However, the cancers that developed in the men taking finasteride looked like they were more likely to grow and spread. The reason for this is not known. The study researchers are continuing to watch these men to see if these cancers truly are more aggressive. At lower doses, this effect is less well-defined.

Recognised side-effects, experienced by around 4% of users, include erectile dysfunction, and less often gynecomastia (breast gland enlargement). In trial studies, side effects ceased after dosage was discontinued.

Side effects

Finasteride is not indicated for use by women. Do not take or handle this medication if you are pregnant or could become pregnant during treatment. Finasteride is in the FDA pregnancy category X. This means that it is known to cause birth defects in an unborn baby. Women who are or who may become pregnant must not handle crushed or broken Finasteride tablets. The medication could be absorbed through the skin. Propecia is known to cause birth defects in a developing male baby. Exposure to whole tablets should be avoided whenever possible, however exposure to whole tablets is not expected to be harmful as long as the tablets are not swallowed. It is not known whether Finasteride passes into breast milk. Finasteride is not intended for use by women and this medication should not be taken if you are breast-feeding a baby. It appears that Finasteride does pass into the semen of men, thus caution should be used to avoid ingestion of semen during oral sex if a woman is pregnant or may become pregnant.

Finasteride can also be used to mask steroid abuse, and many professional sports have banned finasteride use for this reason.

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Finasteride and Prostate Cancer
From Nurse Practitioner, 11/1/03 by Risser, Nancy

ONCOLOGY

* Finasteride and Prostate Cancer Thompson IM, Goodman PJ, Tangen CM, et al: The influence of finasteride on the development of prostate cancer: N Engl J Med 2003;349(3):215-24.

Scardino PT: The prevention of prostate cancer-the dilemma continues. N Engl J Med 2003;349(3):297-299 (editorial).

The results of the first major trial of chemoprevention for prostate cancer do not provide clear answers for clinicians. In the trial, 18,882 men 55 years of age or older who had a normal digital rectal examination and a prostate-specific antigen (PSA) level of 3.0 ng/ml or lower were assigned to treatment with finasteride (5 mg daily) or placebo for 7 years. Prostate biopsies were advised for abnormal digital rectal examination or for PSA of 4.0 or greater.

To achieve a similar biopsy rate in both groups, low PSA values from the finasteride group were corrected by multiplying by 2.4. Prostate cancer was found in 18.4% of the finasteride group and in 24.4% of the placebo group, for a 25% reduction in prevalence over the 7 year period (95% CI 18.6-30.6%;p

It is not known whether finasteride enables the development of more aggressive cancers or whether PSA suppression by finasteride led to delays in biopsy. Urinary symptoms occurred more often in men who received placebo while sexual side effects were significantly more frequent in the study group. Although finasteride prevents or delays the appearance of prostate cancer, the tumors when found are higher grade. It is probably not necessary to stop finasteride in those currently taking it, but clinicians should carefully monitor these patients for prostate cancer.

Copyright Springhouse Corporation Nov 2003
Provided by ProQuest Information and Learning Company. All rights Reserved

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