Dutasteride may slow prostate cancer, but questions remain
Men with localized prostate cancer might find non-surgical treatment with the drug Avodart, generically known as dutasteride. In a study known as REDEEM (REduction by Dutasteride of clinical progression Events in Expectant Management of prostate cancer), investigators found the drug therapy significantly slowed the rate of prostate tumor growth. Dutasteride is currently used for treatment of BPH (benign prostatic hypertrophy).
Dr. Neil Fleshner who led the research said the finding, which is published in the Lancet, is “…very good news for men” with low-risk prostate cancer. Aggressive prostate cancer treatment with surgery can interfere with quality of life from impotence and urinary incontinence that are side effects of surgical intervention."
The study took place over 3-years and enrolled 302 men age 48 to 82 that were diagnosed with low-risk prostate cancer. The men were closely monitored during the study. Biopsy was performed at 1.5 and 3 years.
Progression of prostate cancer was 38% in men given Avodart, compared to 48% among the placebo group.
Treatment with the drug may still be controversial. In an accompanying editorial in the Lancet, Chris Parker, MD, from the Royal Marsden National Health Service Foundation Trust in Sutton, United Kingdom, points out that this improvement in "time to pathological progression" is not significant.
He recommends against using dutasteride because of lack of evidence showing the drug can reduce deaths from the disease.
Parker says, "dutasteride could plausibly have no effect (or possibly a deleterious one) on prostate cancer mortality."
Leonard G. Gomella, MD, of Jefferson University in Philadelphia, who was not involved in the study said, "We are looking for better ways to manage men on active surveillance for prostate cancer. I think the fact that some men in the dutasteride arm had a reduction in the amount of prostate cancer is very encouraging."
At 3 years, 54 of 144 men with localized prostate cancer treated with dutasteride had progression of prostate cancer. In the placebo group 70 of 145 men were found to have progression of the disease.
The authors concluded, “Dutasteride could provide a beneficial adjunct to active surveillance for men with low-risk prostate cancer", but questions still remain as to whether Avodart should be prescribed in lieu of surgical treatment.
The REDEEM trial was sponsored by the drug manufacturer GlaxoSmithKline, where Dr. Fleshner reports he serves as a consultant, adviser, and speaker for the company. Two of the study coauthors are employees of GlaxoSmithKline and some others have financial ties.
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