THERAPEUTIC HOTLINE: Treatment of androgenic alopecia with finasteride may result in a high grade prostate cancer in patients: fact or fiction?

The document discusses concerns that finasteride, a treatment for androgenic alopecia, might increase the risk of high-grade prostate cancer, referencing the Prostate Cancer Prevention Trial (PCPT) that involved 18,882 men and showed a 24.6% reduction in overall prostate cancer incidence but a higher occurrence of high-grade tumors in those treated with finasteride. The authors argue that finasteride likely improved the detection of aggressive cancers due to its impact on prostate size and PSA levels, rather than causing more aggressive cancer. They conclude that a 5 mg dose of finasteride does not raise the risk of high-grade prostate cancer and can be safely used at a 1 mg dose for hair loss, with the recommendation to monitor PSA levels in patients, particularly those with a family history of prostate cancer.