Continuing along the lines of
last Wednesday's theme of 20:20 hindsight, I thought I'd also mention a
study published towards the end of last month in the Lancet in which the authors concluded that
dutasteride might slow down the progression of localized low grade prostate cancer in men interested in active surveillance. It's important to note that this was another analysis of a randomized, double-blind, placebo-controlled trial, Reduction by Dutasteride of Clinical Progrression Events in Expectant Management (REDEEM), in which 289 men average 65 years old w/biopsy proven localized Gleason 5-6 prostate cancer who had elected active surveillance were randomized to dutasteride 0.5mg daily vs placebo and followed for 3 years. We should note that their prostate specific antigen (PSA) was less than 11ng/mL w/life expectancy of at least 5 years.
In the past, we used the phrase watchful waiting. In other words, we just checked & repeated their PSA at regular intervals looking for an increase beyond some pre-specified level. Nowadays, we think of active surveillance in which the patient undergoes repeat biopsy at regular intervals to demonstrate stability of the neoplasm or progression to high grade disease. Again, I can only imagine the look on the faces of those randomized to placebo now slapping their forehead and exclaiming "I could have had a V8" or at least daily dutasteride to slow down the progression of disease.
I thought about this study a bit more and finally realized that the study had been published early online
back in January when I had first written about it. Upon looking back, I'm glad to say that I'm at least consistent. Whether that's good or bad is open to debate. Sure REDEEM was a randomized controlled trial good for demonstrating cause & effect. However, in this situation, reality isn't so much black & white as it is various shades of gray. It turns out that
dutasteride, just like finasteride, can decrease the incidence of prostate cancer but only while increasing the risk of high grade cancer. You'll need to decide for yourself whether less hair loss or improvement in prostate symptoms is worth the potential risk/side effect.
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