5-α reductase inhibitors and prostate cancer prevention: where do we turn now?
1 Division of urology, Department of Surgery, University of Toronto, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
2 Duke Prostate Center, Division of Urologic Surgery, Departments of Surgery and Pathology, Duke University School of Medicine, Box 2626 DUMC, Durham, NC 27710, USA
3 Section of Urology, Veterans Affairs Medical Center, Durham, NC, USA. 508 Fulton Street, Durham, NC 27710, USA
BMC Medicine 2011, 9:105 doi:10.1186/1741-7015-9-105Published: 15 September 2011
With the lifetime risk of being diagnosed with prostate cancer so great, an effective chemopreventive agent could have a profound impact on the lives of men. Despite decades of searching for such an agent, physicians still do not have an approved drug to offer their patients. In this article, we outline current strategies for preventing prostate cancer in general, with a focus on the 5-α-reductase inhibitors (5-ARIs) finasteride and dutasteride. We discuss the two landmark randomized, controlled trials of finasteride and dutasteride, highlighting the controversies stemming from the results, and address the issue of 5-ARI use, including reasons why providers may be hesitant to use these agents for chemoprevention. We further discuss the recent US Food and Drug Administration ruling against the proposed new indication for dutasteride and the change to the labeling of finasteride, both of which were intended to permit physicians to use the drugs for chemoprevention. Finally, we discuss future directions for 5-ARI research.