Serum PSA Suppressed by Baldness-Strength Propecia

[kebaldwin]

Serum PSA Suppressed by Baldness-Strength Propecia

By Peggy Peck, Senior Editor, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
December 05, 2006

MedPage Today Action Points

Explain to interested patients that this study suggests that low-dose finasteride, marketed as Propecia, may suppress serum PSA the way higher-dose finasteride, marketed as Proscar, does when used for benign prostatic hyperplasia.

Explain to interested patients that they should inform their physicians that they are taking Propecia prior to PSA screening.

Explain to interested patients that the relationship observed in this study requires confirmation in a larger study.

Review
DALLAS, Dec. 5 -- As low-dose Propecia (finasteride) stimulates hair growth for male pattern baldness, it appears to suppress prostate specific antigen levels, just like its big brother, Proscar, a researcher here reported.

Men who took 1 mg of Propecia daily for hair restoration for 48 weeks reduced serum PSA levels by 40% to 50%, which limited the efficacy of PSA as a screening tool for prostate cancer detection, found urologist Claus Roehrborn, M.D., at the University of Texas Southwestern Medical Center.

The finding from Dr. Roehrborn and his co-author, Anthony V. D'Amico, M.D., of Brigham and Women's Hospital and the Dana-Farber Cancer Institute in Boston, was released online by The Lancet Oncology and will be published in the January edition.

Proscar, which is higher-strength finasteride, is given at 5 mg/day to treat benign prostatic hyperplasia, and, the authors said, it is well known that the 5-mg dose suppresses PSA. As a result, when men who are taking Proscar undergo PSA screening tests, the recommendation is to multiply the value by two in order to compensate for the effect of Proscar.

The authors said that it had been unknown whether 1 mg of Propecia would have a similar effect.

To find out, they enrolled 355 men ages 40 to 60 with male pattern baldness. They were stratified by decade, 40 to 49 and 50 to 60, and randomized in a four-to-one ratio to Propecia (1 mg/day) or placebo. The primary endpoint was effect on serum PSA at 48 weeks.

The median decrease in serum PSA was greatest among men ages 50 to 60 randomized to Propecia -- 50% (95% CI 44%-57%) compared with a median increase of 13% (95% CI 2% to 24%) for same-aged men who were randomized to placebo.

For men ages 40 to 49 the median decrease was 40% (range 34% to 46%) for those in the Propecia arm versus 0% median change for men in the placebo arm (range -14% to 14%).

The authors said the risk of BPH increases with age, which might explain the greater effect observed in the older cohort.

The findings, they said, suggested "that 1 mg/day [Propecia] affects the serum PSA concentration similarly to 5 mg/day [Proscar] over 1 year."

More studies are needed to determine whether this pattern would hold over a larger population or "whether a lower PSA cutoff, on an increase of at least 0.3ng/mL above the established nadir to recommend prostate biopsy in men receiving a 5a-reductase inhibitor will result in increased detection of high grade disease compared with men not receiving a 5a-reductase inhibitor."

But until such studies are completed, the authors recommend that PSA results from men taking Procepia should be doubled in the same way as samples from men on Proscar therapy in order to compensate for the finasteride effect.

The study was funded by Merck & Co., Inc., the maker of finasteride, and the authors disclosed no financial conflicts.

Primary source: The Lancet Oncology
Source reference:
D'Amico AV and Roehrborn CG "Effect of 1 mg/day finasteride on concentrations of serum prostate-specific antigen in mend with androgenic alopecia: a randomized trial." Lancet 2006 Published online xx xx

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[kebaldwin]

I thought that male pattern baldness was related to prostate problems?

aren't DHT problems common to both?

http://www.google.com/search?hl=en&lr=&q=dht+baldness

http://www.google.com/search?hl=en&lr=&q=dht+prostate

so shouldn't baldness cures help prostate and prostate cures help baldness?

obviously I am missing something ...

[kaypeeoh]

I did a quick google scholar search for finasteride. One abstract showed that 5mg finasteride was effective at reducing the size and symptoms of benign prostatic hypertrophy. Another abstract showed NO reduction of symptoms taking the same 5mg dose. In both baldness and BPH testosterone must first be converted to DHT. Finasteride prevents that conversion. What I can't find is theories about DHT's formation in the first place.

With age testosterone levels slowly decline while estrogen levels go up. Shippen's book, The Testosterone Syndrome, says DHT is the more biologically active than testosterone. There are estrogen receptors in the prostate. Estrogenic compounds like soy can bind these receptors, blocking the actions that estrogen itself is causing.

Shippen then says Saw Palmetto has been shown to suppress the conversion even better than finasteride does, but without the main side effect of finasteride: impotence. (!)

[kebaldwin]

One abstract showed that 5mg finasteride was effective at reducing the size and symptoms of benign prostatic hypertrophy.

which is why I question what these researchers are thinking. If baldness drugs also help with prostate - why are they worried about prostate numbers improving. Only thing I can figure is that the prostate people are mad because men are not on both baldness drugs and prostate drugs (the prostate drug people are not getting their money).

Another abstract showed NO reduction of symptoms taking the same 5mg dose.

Must have been the prostate guys doing that test :-)

In both baldness and BPH testosterone must first be converted to DHT. Finasteride prevents that conversion. What I can't find is theories about DHT's formation in the first place.

Testosterone is converted to DHT in the presence of the enzyme 5-alpha-reductase.

With age testosterone levels slowly decline while estrogen levels go up. Shippen's book, The Testosterone Syndrome, says DHT is the more biologically active than testosterone. There are estrogen receptors in the prostate. Estrogenic compounds like soy can bind these receptors, blocking the actions that estrogen itself is causing.

Plus eating high glycemic foods generates estrogens, most meat now contains high level of estrogens (to make the animals grow faster and fatter), pollutants increase estrogen, poor nutrition decreases testosterone and increases estrogen, etc - there are too many reasons that men today are having problem with manhood.

Shippen then says Saw Palmetto has been shown to suppress the conversion even better than finasteride does, but without the main side effect of finasteride: impotence. (!)

Saw Palmetto an pumpkin seed are both very good.

Saw Palmetto, Pygeum, nettle and beta sitosterol are useful for benign prostatic hypertrophy (BPH).

http://www.vitacost.com/MensHealth.html

http://www.vitacost.com/Science/hn/Concern/BPH.htm

men also need to take manly vitamins and minerals such as B vitamins, magnesium, zinc, etc.

Life extension foundation (www.LEF.org) has some great blood tests where they can test for all the hormones. I have been building muscle for 4 years and my last blood test -- my DHT and estrogens were very low. Testosterone was not as high as i wanted -- but the bad things were not happening.

The funny thing (well not so funny really) is that doctors know that testosterone is converted to DHT and DHT is bad. So for many doctors their solution is to eliminate testosterone in men! I am NOT kidding.

Instead of stopping the conversion of testosterone to dht - they try to reduce testosterone! Crazy medical world we live in!

[kaypeeoh]

Castrated dogs and cats have zero incidence of prostatic disease. In older intact male dogs BPH is as common as in older men.

[Nancy LC]

Castrated dogs and cats have zero incidence of prostatic disease. In older intact male dogs BPH is as common as in older men.Wow! So we could cure it! *evil chuckle*