On one hand the critics of PSA don’t like it because men are diagnosed with non aggressive disease and subjected to debilitating treatments. Along comes the use of Avodart that disguises the less aggressive form of prostate cancer and increases of the more aggressive prostate cancer. If you have been reading all the problems about the PSA you would think this is just what some folks would want. So what is it? Do or do you not want to find your prostate cancer sooner and have the choice if aggressive treatment is for you, or would you rather only be diagnosed if it is aggressive and really really needing treatment. Again, I think this makes the point that if one looks at the argument from the standpoint of “If it were me, what would I do?” then you’ll get to the real crux of the issue.
Bloomberg
Glaxoʼs Avodart May Give Men False Security on Prostate Cancer
March 31, 2010, 5:16 PM EDT By Michelle Fay Cortez
March 31 (Bloomberg) — GlaxoSmithKline Plcʼs Avodart, shown in a study to reduce the detection of prostate cancer, may give men “a false sense of security,” according to an editorial in the New England Journal of Medicine.
Men taking Avodart were 23 percent less likely to be diagnosed with prostate cancer during a four-year study that compared the treatment for an enlarged prostate to a placebo. The drug likely shrank the size of existing, low-risk tumors rather than prevented the development of deadly new cancers, wrote Patrick C. Walsh, from Johns Hopkins Medical Institutionsʼ Urological Institute in Baltimore.
Avodart significantly reduced the size of the prostate and made it easier for men to urinate, according to the study first presented at the American Urological Association meeting last year. The medicine also lowered levels of PSA, a protein used to help detect cancer in a common blood test. The lower PSA may slow discovery of more serious prostate cancers, the most common tumor in men, Walsh said in an editorial accompanying the study.
“Because PSA levels are suppressed, men may have a false sense of security,” Walsh wrote. “If prostate cancer ever develops, the diagnosis may be delayed until they have high- grade disease that may be difficult to cure.”
The reduction in the number of lower grade tumors is important, said Claire Brough, a Glaxo spokeswoman, in an e- mailed statement. ʻPotential Benefitʼ
“A high proportion of lower grade tumors are treated aggressively with procedures such as radical prostatectomy, radiotherapy, or the combination of both,” she said. “A reduction in the over-diagnosis and over-treatment of these lower grade ʻclinically insignificantʼ tumors would be a potential benefit of treatment.”
Prostate cancer detection is a sensitive topic, because studies have shown as much as half of older men have unnoticed tumors when they die. Doctors and researchers have struggled to find methods that identify only high-risk tumors, those most likely to cause symptoms and potentially kill.
Almost 200,000 men in the U.S. are diagnosed with prostate cancer each year, and 27,360 die from it, according to the American Cancer Society.
The Glaxo-funded study tracked 6,729 men who had an elevated risk for prostate cancer because of their age, high PSA levels or previous suspicion of cancer. All underwent a biopsy, and had no signs of cancer, within six months before starting the study. After four years, 20 percent of men given Avodart and 25 percent of those on placebo were diagnosed with prostate cancer based on scheduled biopsy results, the study found.
Aggressive Cancers
Men given Avodart were more likely to be diagnosed with the most aggressive cancers than those given placebo, though the numbers were small in both groups. A dozen men taking Avodart were diagnosed with the most dangerous cancers in the third or fourth year of the study, compared with just one on placebo. Heart failure, which was also rare, was higher in Avodart patients.
Men diagnosed with prostate cancer during the first two years of the study were withdrawn for treatment. More of those patients were getting placebo than Avodart, reducing the number of patients in the placebo arm who might have progressed to more serious cancers, said researchers led by Gerald Andriole from Washington University School of Medicineʼs urology division. The difference might also stem from the drug, they said.
Avodart, known chemically as dutasteride, “may be considered as a treatment option for men who are at increased risk for prostate cancer,” the researchers concluded.
–Editors: Kristen Hallam, Donna Alvarado To contact the reporter on this story: Michelle Fay Cortez in London at mcortez@bloomberg.net
Prostate Diaries 