I am 45 years old.  My father died of metastatic prostate cancer.  My psa scores the past six years have been:  1.4, 1.3, 1.43, 1.74, 1.7, and 1.5. (Unfortuntately, these were not all at the same lab or using the same assay).  I am generally in good health. I gather than my family history and significantly above-normal psa for my age puts me at an increased risk for prostate cancer. Would you recommend that I take finasteride or dutasteride to reduce my risk of prostate cancer?  I saw two reputable urologists, both of whom are familiar with the reported results of the REDUCE trial — one said “probably should take it” and the other said “I would not take it.”  What do you recommend?  (And if I should take one of them, which one?).   Thank you!


At this point, the clinical trials have been definitive: these drugs reduce the risk of prostate cancer. The major side effect is that about 20% of men have a drop in sex drive. However, this side effect is reversible – it disappears when you stop the drugs. On the plus side, these two drugs significantly increase serum testosterone. This increase in testosterone mean that these drugs can increase performance in sports that require muscle power. This is enough of an issue that both drugs are screened for in international athletics like the Olympics. Additionally, I have noted that a significant proportion of men may actually have an increase in sex drive. As a medical oncologist, I do not often get to prescribe drugs that enhance performance! It is hard to imagine any physician not recommending finsteride or Avodart. I would be interested in why one of your physicians did not recommend it.

There are other issues you should consider. The consumption of grilled red meat seems to be consistently associated with an increased risk of prostate cancer as well as heart disease. I would recommend you minimize your consumption of red meat and dairy fats and favor the intake of fish, white meat of poultry, grains and legumes.

Vitamin D deficiency is a common problem in men with prostate cancer and has many adverse health consequences. You should have your serum vitamin D level measured and take steps to make sure you are not deficient in this vitamin.

There also seems to be a benefit from being lean and exercising regularly. Again, these offer general health benefit in addition to whatever benefit they offer for prostate cancer.