Chemoprevention of prostate cancer just prescribed

Despite the favorable position of the European Association of Urology, the prevention of prostate cancer by finasteride is not prescribed by doctors, according to a study published in the journal Cancer Epidemiology, Biomarkers & Drug prevention or chemoprevention has been studied for several cancers (breast, prostate, colorectal). In 2003, the PCPT (Prostate Cancer Prevention Trial) study showed that finasteride, a drug indicated for the treatment of benign prostatic hypertrophy, could reduce by 25% the incidence of cancer of this organ in men low risk for this cancer aged 55 and over.
However, concern about the risk of high-grade tumors occurred in this study (6.4% in the arm taking finasteride against 5.1% for those who did not take). This uncertainty has since been lifted, the observed increase is due to better detection.
In 2009, the European Association of Urology (EAU) said at its congress in Stockholm that the evidence of a protective effect were "sufficient for physicians to discuss with their patients the use of this drug to prevent cancer prostate cancer, especially if the patient has risk factors. "
Robert Hamilton and his colleagues at the National Center for Health Promotion and Disease Prevention, Durham (North Carolina) wanted to assess the knowledge and the actual practice of physicians. To do this, they analyzed the requirements of finasteride 464 primary care physicians and urologists 135 U.S. between 2000 and 2005, during which were published the results of the PCPT.

The number of patients receiving a first prescription finasteride increased throughout the study period. Indeed, 57% of urologists and 40% of GPs prescribed this medication more frequently in 2006 than they did five years ago.
The publication of the results of the PCPT trial did not cause a change in this trend, the researchers note.
By focusing on patterns of treatment, the authors found that a large majority of physicians (64% of urologists and 80% of GPs) never prescribed finasteride as a preventive treatment for prostate cancer.
The reasons differ depending on the type of doctors: Most urologists (55%) recall concerns over the increased risk of high-grade tumor, and have not built the lifting risk doubt, while half of the general (52%) simply did not know that finasteride could be used for chemoprevention.
The results of the PCPT were widely disseminated in the mainstream press, but most primary care physicians have said ignore the use of finasteride for chemoprevention. We have not been able to find an explanation for this lack of information, although it is probably multifactorial, comment the researchers.
Moreover, the lack of interest of patients could be another limiting factor for the use of this drug in a prevention indication, they argue ..