Regarding Prostate-Specific Antigen: Let's Not Shoot the Messenger

Two large prospective randomized trials tested the 5α-reductase inhibitors finasteride and dutasteride against placebo for prostate cancer chemoprevention in middle-aged and elderly men. The trials showed that these inhibitors significantly decreased the incidence of low-grade prostate cancers (Gleason score ≤ 6) but also resulted in a nearly 2-fold increase in high-grade prostate cancers (Gleason score 8–10). For every high-grade cancer developed as a result of the therapy, four low-grade cancers were avoided. These findings, which have been scrutinized by the FDA, align with previous research showing an increase in prostate cancer in men treated with finasteride who have high-grade prostatic intraepithelial neoplasia. The paper suggests that the reduction in prostate tissue PSA concentration over time due to 5α-reductase inhibitors might promote high-grade prostate cancer, raising concerns due to the drugs' common use for benign prostatic hyperplasia and male pattern baldness.