Prostate Cancer Survivors






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Re: Avodart affect on biopsy tissue Gleason score ?

It has been a while since I was taking Avodart, but back then I took an interest in the effects of Avodart on various factors, including PSA and Gleason grading. Looking back over my notes, I came across this :

There were two different clinical trials (the Prostate Cancer Prevention Trial and the REDUCE trial) that identified a lower rate of positive biopsies for those treated with one of the 5 alpha-reductase inhibitors. These inhibitors are dutasteride (Avodart) and finasteride (Flomax), Quoting from the REDUCE Study Group “the major effect of dutasteride is the shrinkage of prostate tumors or inhibition of their growth”.

However, both trials did show a higher number of higher grade cancers, especially in later years of the trials. There are many researchers who believe that the incidence of higher grade cancers is due to one or a combination of factors including biopsy sampling density bias, grading bias and the effect of more men in the placebo groups leaving the trials with their higher rate of diagnosed cancer. As for grading bias, quoting Civantos et al “finasteride may induce some foci of lower grade cancer to resemble higher grade cancer" and David G Bostwick states “finasteride treatment is likely to overestimate the biologic potential of high grade cancer”.

So if you believe those two gentlemen (Civantos and Bostwick) there is a change in the pathology of cancer cells that makes lower grade cancers look more like higher grade cancers and thereby affect Gleason grading.

Re: Avodart affect on biopsy tissue Gleason score ?

Brian I find very interesting the statement that “finasteride may induce some foci of lower grade cancer to resemble higher grade cancer." Really?
About 6 years ago I was diagnosed with a small amount of GS 6 PCa. I decided to go on A.S. with PSA tests every 3 months. My uro supported my A.S. but he seemed more concerned about my PSA velocity which he felt was greater than it should be for the small amount of cancer I seemed to have (2 cores each <5%). He put me on finasteride. It did slow the increase in PSA, but it did not stop it. I took it for about 18 months but stopped because I felt that the finasteride might be masking the "real" PSA level. My next biopsy showed I now appeared to have GS 8 PCa. Are you saying there exists the possibility that my GS 8 cancer might not have been "real" GS 8, but only GS 6 made to "resemble" GS 8?

Re: Avodart affect on biopsy tissue Gleason score ?

Joe, you can find the statement "finasteride may induce some foci of lower grade cancer to resemble higher grade cancer" in the paper:

The whole paper is long but interesting. For the quote, scroll down to paragraph 3 of the Discussion, where reference 21 is shown.

Re: Avodart affect on biopsy tissue Gleason score ?

Thanks for the replies, who is the individual replying in the original quote I copied?

Re: Avodart affect on biopsy tissue Gleason score ?

Maybe you should take your doctor's advice and get cured while you are young. A good surgeon in combination with your youth should mitigate the side effects: a stitch in time...