Pros and cons of fi­nas­teride treat­ment for en­larged prostate

Moose Jaw Times Herald - - LOCAL -

I have an en­larged prostate but no di­ag­nosed prostate cancer, hav­ing had a prostate MRI.

My most re­cent exam showed an en­larged prostate. My PSA is still be­low 4, and I have been tak­ing two tam­su­losin pills daily, but from time to time I get up more than sev­eral times dur­ing the night. My doc­tor is rec­om­mend­ing adding fi­nas­teride to my reg­i­men to help shrink my prostate and re­duce get­ting up in the night. That is a big plus. He said I might grow more hair, but noth­ing else neg­a­tive or pos­i­tive. In spite of some neg­a­tives I have read, I am in­clined to go ahead and give it a try. What do you think?

Fi­nas­teride blocks a form of testos­terone that is re­spon­si­ble for both prostate en­large­ment and hair loss. It is com­monly used in com­bi­na­tion with medicines like tam­su­losin (Flo­max), as the two medicines work very dif­fer­ently and thus have ad­di­tive ben­e­fi­cial ef­fects.

There are two con­cerns about fi­nas­teride. The first is that some stud­ies showed an in­crease in ag­gres­sive prostate cancers in men tak­ing fi­nas­teride. Sub­se­quent analy­ses have sug­gested that this is due to a method­ologic weak­ness in the study, and I think the risk of prostate cancer is lower in men tak­ing fi­nas­teride, com­pared with those not tak­ing it.

The se­cond is that you should ex­pect your PSA to go down by 50 per­cent when on fi­nas­teride. If it doesn’t, that’s ev­i­dence that your PSA may have ac­tu­ally gone up at the same time, and it should be eval­u­ated by your doc­tor.

I am a healthy 80-year-old fe­male. I had surgery to re­move my uterus, ovaries, fal­lop­ian tubes and cervix when I was 65. No cancer was found any­where. I have con­tin­ued to go for a yearly Pap smear, but it seems point­less to con­tinue to do this. What is your opin­ion?

I agree with the guide­lines from the U.S. Pre­ven­tive Ser­vices Task Force that screen­ing for cer­vi­cal cancer in women who have had nor­mal reg­u­lar screen­ing (which I as­sume is the case with you) is no longer ap­pro­pri­ate af­ter age 65, ex­cept in women with a his­tory of cer­vi­cal cancer. I know that some of my col­leagues con­tinue to rec­om­mend per­form­ing the test even in older women, and I am sure they are do­ing so out of a de­sire to help. How­ever, the like­li­hood of de­vel­op­ing cer­vi­cal cancer af­ter age 65 is very small, and there is the po­ten­tial for harm if a false­pos­i­tive test leads to an un­nec­es­sary pro­ce­dure. Be­cause the po­ten­tial for harm ap­pears to be greater than the po­ten­tial for ben­e­fit, I rec­om­mend against Pap smears in women over 65 who have al­ways had nor­mal Pap smears.

I know that some physi­cians use a Pap smear to get women to com­ply with their an­nual exam. I think a pe­ri­odic visit with a provider on an an­nual ba­sis is a good idea: It al­lows for other ap­pro­pri­ate screen­ing, in­clud­ing for blood pres­sure and de­pres­sion, both com­mon prob­lems among the el­derly. A gy­ne­co­log­i­cal exam is ap­pro­pri­ate for women; how­ever, the Pap smear it­self is un­likely to lead to sig­nif­i­cant ben­e­fit in this age group.

The top­ics of uter­ine fi­broids and hys­terec­tomy are cov­ered in the book­let on women’s health. To ob­tain a copy, write: Dr. Roach Book No. 1106 628 Vir­ginia Dr. Or­lando, FL 32803 En­close a check or money or­der (no cash) for $4.75 U.S./$6 Can. with the re­cip­i­ent’s printed name and ad­dress. Please al­low four weeks for de­liv­ery.

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