Receipt of 5-Alpha Reductase Inhibitors Before Radical Cystectomy: Do They Render High-Grade Bladder Tumors Less Aggressive?

Topical androgen receptor antagonists may not be necessary if 5-AR inhibitors like finasteride or dutasteride effectively reduce DHT levels. Combining a 5-AR inhibitor with a topical androgen antagonist could potentially enhance treatment, but oral use of androgen antagonists is too risky due to severe side effects.

The conversation discusses the need for a localized 5-alpha reductase inhibitor that only affects the scalp without systemic side effects, similar to pyrilutamide's approach. Current treatments like topical liposomal finasteride and dutasteride are mentioned, but concerns about their systemic effects and lack of research are highlighted.

FCE 28260 (PNU 156765), an under-explored 5α-reductase inhibitor, showcases promising results in research by Giudici et al., outperforming well-known treatments like Finasteride in reducing the conversion of testosterone to DHT. Its superior efficacy, demonstrated through lower IC50 values in both natural and human recombinant enzyme studies, suggests it could offer more effective management of DHT-related conditions. Additionally, its lower molecular weight hints at better potential for topical application, potentially offering advantages in treating conditions such as androgenic alopecia. Despite its potential, it has not advanced in development, possibly due to financial limitations, leaving its therapeutic prospects and side effect profile largely unexplored.

The conversation is about considering pyrilutamide 1% as an alternative treatment for hair loss due to intolerance to 5-alpha reductase inhibitors. Some users suggest it might be effective, while others view it as a temporary solution.

Some individuals experience side effects from 5AR inhibitors like finasteride and are considering hair transplants without these medications, with some opting for surgeons like Dr. Zarev. Others are exploring alternative treatments and waiting for new medications in development, while some discuss managing side effects through lifestyle changes or additional medications.

Pyrilutamide is considered by some as an alternative for those avoiding 5AR inhibitors like finasteride and dutasteride, but opinions on its effectiveness vary. Some users report similar results with fluridil and pyrilutamide, while others find pyrilutamide less effective compared to prescription treatments.