Proscar and Propecia: A Therapeutic Perspective

The document discussed the therapeutic use of finasteride, marketed as Proscar and Propecia, in treating benign prostatic hyperplasia (BPH) and its potential role in prostate cancer prevention. Initial studies showed that finasteride effectively reduced prostate size by inhibiting 5-reductase activity, which converts testosterone to dihydrotestosterone (DHT). A significant trial involving men aged 55 and older revealed that while finasteride decreased low-grade prostate cancer incidence, it unexpectedly increased high-grade cancer cases, leading to the trial's early termination. Despite these findings, Proscar was deemed reasonable for BPH treatment, though its use for cancer prevention was discouraged. The document also highlighted the oversight in addressing the implications of Propecia (1 mg finasteride) for baldness treatment, noting similar hormonal effects between the 1 mg and 5 mg doses. A large trial with nearly 900 men showed that 5 mg finasteride improved urinary symptoms more than placebo, while both doses equally affected prostate size and urinary flow, suggesting similar efficacy.