Friday, April 9, 2010


Sometimes referred to as the prostrate which is fine since the prostrate position protects the prostate.  Anyway,  there's a new twist in the marketing for this much maligned little organ.

Cancer prevention through a pill!   Woohoo!   What can possibly go wrong?

This is the craziest headline ever.  

Heart failure risk linked to prostate drug

FDA recently approved Avodart as a cancer preventive medication for men

I have a copy of the study they're referring to in the article.   They took men with elevated PSA tests and a set of negative prostate biopsies and labelled them high risk.  These men were then placed on a prostate shrinking drug called Avodart or a placebo.  They had another set of biopsies at 2 years and at 4 years.  

There were more men with a positive biopsy for cancer at both 2 and 4 years in the placebo group.  

Turns out that 70% of the benefit was in slow growing cancers.   You can try and predict which cancers are slow growing and unlikely to spread and those which are fast growing based on how abnormal the cells look under the microscope,  it's called a Gleason's score.  Most of the benefit was in preventing or delaying or masking the more benign cancers.  When men are diagnosed with the slow growing prostate cancers there's a lot of treatment options including "watchful waiting".   Where you can tell a man that his cancer is so slow growing that we can't make you any healthier treating it with radiation or surgery only harm you.  

Well what about the cancers that have already spread did Avodart prevent them?   No sir,  there weren't any like that found in this study.

What about the more aggressive looking ones on the biopsy,  with a high Gleason's score?  

Well the highest scores the last 2 years of the study were found more often in the Avodart group.   And of the most aggressive looking cancers found on biopsy those last 2 years of the study,  14 were in the Avodart group and 1 in the placebo group.  

So what will happen is this "prevention" will be applied to all men with a high PSA or with a family history or certain races.  Sure looks like it might be causing aggressive prostate cancers and why are we trying to use a "prevention" when the PSA test has been proven to harm about 48 men for every 1 it saves?

Don't get me started on the rate of side effects