BPH Medication and Prostate Cancer

The medications used for treating BPH can mask true PSA levels; based on prior research, the PSA value should be doubled. I didn’t know that and evidently neither do many of the men who take the medications known as 5-alpha reductase inhibitors. Does it have an impact on prostate cancer diagnosis and mortality?

Researchers examined a large group of men treated at the Veterans Administration to answer that question. They compared men that did and did not use one of the medications to see if there were differences in when men were diagnosed via biopsy, the severity of the cancer at treatment, and the death rate between medication users and non-users. The results showed that the men who were taking the type of medications known as 5-alpha reductase inhibitors were diagnosed later, had more advanced disease, and died at a higher rate than those who didn’t use those types of medications.

One type of 5-alpha reductase inhibitor, finasteride, has a familiar name: Propecia or Proscar, which is also used to treat male-pattern baldness. Taking one of those meds can affect PSA, so be sure to discuss that with your doctor.

Does this mean that men shouldn’t use the medication? That’s a personal choice. To me, it means that both the man and his physician should be aware of the problem, have regular PSA tests, and double the value of the results. That way, the prostate cancer won’t be masked by the medication and like every type of cancer, the sooner it’s diagnosed, the sooner treatment can begin if warranted.

And that raises another issue: what about men who take herbs for BPH? Are they at risk? I’ll let you know what I found on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: JAMA Intern Med. 2019;179(6):812-819. doi:10.1001/jamainternmed.2019.0280.