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Meds for enlarged prostate may mask prostate cancer

A man and a doctor talking in an office setting.

May 28, 2019—An enlarged prostate can cause urinary problems like having to go too often, leaking urine or having a weak stream. Medications can help control those symptoms, but they come with risks of their own. In fact, one common class of medicines may make it harder to detect prostate cancer in its early, more treatable stages.

The drugs are called 5-alpha-reductase inhibitors (5-ARIs). They include finasteride (Proscar) and dutasteride (Avodart). And men who take them may face significant delays in the diagnosis of prostate cancer, a new study shows.

The prostate cancer connection

Prostate cancer often raises the level of a substance called prostate-specific antigen (PSA) in the blood. So testing PSA levels is one way doctors can screen men for possible prostate cancer. Other things can raise PSA levels as well, so a biopsy is usually needed to confirm cancer.

Past studies have shown that 5-ARIs may drive down PSA blood levels by about 50%.

As a result, in a recent study of 80,875 men diagnosed with prostate cancer, men taking 5-ARIs were:

  • Diagnosed on average two years later than other men.
  • Twice as likely to have advanced prostate cancer.
  • Nearly 40% more likely to die from prostate cancer.

The study doesn't suggest that 5-ARIs are unsafe or cause advanced prostate cancer, the researchers said. But they may cause doctors to miss a significant rise in PSA levels.

PSA screening can still be useful for men who take 5-ARIs, the researchers said, so long as doctors take into account how much the drugs may lower PSA levels when deciding whether to recommend a biopsy to check for prostate cancer. When considering prostate cancer screening, be sure to tell your doctor if you are taking a 5-ARI.

The study appeared in JAMA Internal Medicine.

Is prostate cancer screening right for you?

Prostate cancer screening has benefits and risks. So men should talk with their doctors about whether to have a PSA test. This quick quiz can help you start the conversation.

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