Will dutasteride prevent PC from getting worse? -- Johns Hopkins

[I.P. Freely]

Johns Hopkins Health Alerts: Prostate Disorders

* 5-ARIs and the Progression of Prostate Cancer

In this health alert, Johns Hopkins experts answer the question, "Will
dutasteride prevent my prostate cancer from getting worse?"

A 2012 study conducted at Brady Urological Institute at Johns Hopkins
found that it's very unlikely that 5-alpha reductase inhibitors
(5-ARIs) -- a class of drugs that includes dutasteride and finasteride
(Proscar) -- can prevent the progression of prostate cancer.

The study included 587 men with low-risk prostate cancer who had
participated in an active surveillance program. Forty-seven of the men
were taking a 5-ARI for lower urinary tract symptoms (LUTS). After
roughly two years, these men experienced dramatically lower
prostate-specific antigen (PSA) scores and a substantial reduction in
prostate size -- both expected outcomes since 5-ARIs lower PSA scores
and help shrink the prostate. But tissue samples from at least two
annual biopsies found no significant difference in the growth or grade
of prostate cancer in men taking 5-ARIs.

Another reason not to take these medications to prevent prostate
cancer progression: In 2011 the U.S. Food and Drug Administration
warned that 5-ARI use was associated with an increased risk of being
diagnosed with high-grade prostate cancer.

Doctors are not recommending that you stop taking 5-ARIs if you have
lower urinary tract symptoms. The absolute risk of advanced prostate
cancer is low. Still, because 5-ARIs artificially lower PSA levels
your doctor will need to adjust your PSA results up.

[Alan Meyer]

On 05/01/2013 12:14 PM, I.P. Freely wrote:
> Johns Hopkins Health Alerts: Prostate Disorders
>
> * 5-ARIs and the Progression of Prostate Cancer
>
> In this health alert, Johns Hopkins experts answer the question, "Will
> dutasteride prevent my prostate cancer from getting worse?"
>
> A 2012 study conducted at Brady Urological Institute at Johns Hopkins
> found that it's very unlikely that 5-alpha reductase inhibitors
> (5-ARIs) -- a class of drugs that includes dutasteride and finasteride
> (Proscar) -- can prevent the progression of prostate cancer.
>
> The study included 587 men with low-risk prostate cancer who had
> participated in an active surveillance program. Forty-seven of the men
> were taking a 5-ARI for lower urinary tract symptoms (LUTS). After
> roughly two years, these men experienced dramatically lower
> prostate-specific antigen (PSA) scores and a substantial reduction in
> prostate size -- both expected outcomes since 5-ARIs lower PSA scores
> and help shrink the prostate. But tissue samples from at least two
> annual biopsies found no significant difference in the growth or grade
> of prostate cancer in men taking 5-ARIs.

I can't help thinking that an awful lot of scientific publishing, even
from prestigious institutions like Hopkins, is written to satisfy
"publish or perish" requirements and advance academic careers.

I could have sworn that one of the articles in Hopkins' weekly email
updates said that intermittent ADT patients should take 5-ARIs in the
off period in order to slow the growth of the cancer and prolong the
time before resuming Lupron. Do these docs talk to each other? Do they
read each other's publications? When they publish an article like the
above, shouldn't they at least say something about any contradictory
advice that came out of Hopkins just within the last few months?

> Another reason not to take these medications to prevent prostate
> cancer progression: In 2011 the U.S. Food and Drug Administration
> warned that 5-ARI use was associated with an increased risk of being
> diagnosed with high-grade prostate cancer.

...

This study has been quoted so many times you'd think that its
conclusions were actually true.

Another study done after this one claimed that the conclusions of this
5-ARI study were invalid. They claimed that the shrinking of the
prostate caused the tumor cells to be concentrated in a smaller volume,
which led to more biopsy samples showing cancer and with a higher
concentration of higher Gleason cells. The second study went over the
math in the first one and claimed to show that the data from the
original FDA study supported the higher density conclusion, not the
higher grade cancer conclusion.

Maybe that second study is wrong. Maybe the original study was right.
But it seems wrong to me to cite the original study and make
recommendations based on it without even mentioning that there is a
possible reason to believe that its conclusion is bogus.


One day perhaps we'll develop artificial intelligence to the point where
a computer program can read a scientific article, compare it to a
database of already published articles and tell us:

Are the conclusions new?
Do they follow from the published evidence?
Do they conflict with conclusions of other studies?
Do they cite evidence from already
Do we already have strong evidence that the new conclusions are false?

If such a program is ever developed I bet it will discover that 95% of
scientific publishing is BS.

Alan

[I.P. Freely]

Alan Meyer wrote:
>
> I can't help thinking that an awful lot of scientific publishing, even
> from prestigious institutions like Hopkins, is written to satisfy
> "publish or perish" requirements and advance academic careers.
>

...

> If such a program is ever developed I bet it will discover that 95% of
> scientific publishing is BS.

I've forgotten the number, but one analysis (I've forgotten whether it
was a peer reviewed study or just an extensive literature examination)
indicated that far more than 50% of peer reviewed studies are
fraudulent, due to publication rush and/or desire for fame.

That leaves me a bit edgy about basing my decision to forgo SRT on
peer-reviewed research, BUT ... that's also the foundation for the
evidence-based treatment our doctors provide. In fact, in my case the
very doctors who advise my SRT are among the authors of the very study
most relevant to my decision, and other studies they cite support me,
not my doctors

But since our doctors are required to use this peer-reviewed "evidence"
as THE basis for their treatment, what else can we do but read it
ourselves to double-check them? The cardiologists I consulted verbally
hit me over the head with their obligatory slavery to published
evidence-based treatment, but their other comments and their treatment
ignored considerable recent peer-reviewed published research.

I.P.