Will meds affect prostate cancer?

Dear Dr. Roach: I’ve had low-grade prostate cancer for several years and am presently on “active surveillance.” My PSAs have been high but steady. I have a greatly enlarged prostate.

I would like your opinion regarding finasteride (Proscar), as I am considering taking it. I see one of its side effects is that it increases the risk of developing a very serious form of prostate cancer. — D.N.W.

A 2013 study showed that although finasteride reduced the overall risk of prostate cancer from 15% to 10% in men followed up to 18 years on finasteride, there was a small increase in high-grade, aggressive prostate cancer, from 3% to 3.5%. However, there was no increased risk of prostate cancer death among treated men.

Several follow-up studies have suggested that the apparent small increase in aggressive prostate cancers reflected an easier ability to find these cancers. My view is that the apparent increase in aggressive prostate cancer is unlikely to represent a real danger in taking finasteride.

Dear Dr. Roach: I have breast cancer and am being recommended anastrozole. Can you tell me the side effects? — Anon.

Anastrozole is an inhibitor of the enzyme aromatase, which converts androgens made in the adrenal gland to estrogens.

Aromatase inhibitors have been used for over 20 years. There are short-term effects, and these limit the ability of some women to tolerate their use.

Symptoms can be severe in up to a third of women taking it, but regular exercise and anti-inflammatory drugs are effective in reducing these symptoms.

There are sexual side effects for many women. Estrogen is needed for vaginal health.

Fatigue, forgetfulness and poor sleep are often reported by women on anastrozole.