In one study of 1,600 men with BPH, finasteride shrank prostate size over a two-year period by an average of 25 percent, improved urinary flow signifi-candy in 31 percent of the patients, and brought some relief of symptoms in 71 percent of these men. Finasteride achieved this benefit with very few side effects—the main one being the development of impotence, which occurred in only 3.4 percent of men and was reversible when the men stopped taking the drug.

Results from this and other studies show that while this drug is helpful, it’s riot for everybody. The gains in urine flow, for example, are much higher in men who undergo the TUR procedure, and for men with minimal symptoms, these gains would hardly be noticeable. However, the drug might prove helpful in men with moderate to severe symptoms of BPH—for example, those with a weak urinary stream, hesitancy in starting urination, or who are making so many nighttime trips to the bathroom that they’re losing sleep.

The bottom line: Currently, a man taking finasteride has about a 30 percent chance of seeing a significant improvement in his symptoms—and this will come only after six months to a year of taking the drug. Finasteride is not a fast-acting treatment for BPH. Its major advantage is that it causes the prostate to shrink—and in control studies, it appears that once the prostate does shrink, it tends to stay shrunk. Perhaps most exciting is that it may prevent the disease of BPH from progressing.

However, there’s another point worth noting: About 10 percent of men who undergo prostatectomy for the treatment of BPH are found to have some cancer in the bits of prostate tissue that are removed. But in men taking medicine to treat BPH, the presence or absence of prostate cancer is less easily determined.

One concern with finasteride is that it lowers concentrations of prostate-specific antigen (PSA) in the blood by 50 percent. Why is this a problem? In recent years, the PSA blood test has become an important means of checking for prostate cancer, and finasteride could obscure the results of this test in the men who are taking the drug. Therefore, before embarking on a long-term course of finasteride, it’s vital to have a digital rectal exam and PSA blood test and, if your PSA is high (see discussion of PSA in Chapter 3), a prostate biopsy to rule out the presence of cancer.

Once a man is on finasteride, his PSA levels should drop about 50 percent during the first year and then remain constant. If his PSA levels fall to less than 50 percent, or if they start to rise while he’s on the drug, something’s not right, and there are two possibilities. One is that he’s not taking the drug regularly or properly. The other is far more serious—he could have prostate cancer. In any event, a change in PSA levels definitely needs to be investigated.


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