There are many advocates of adding Avodart (dutasteride) or Proscar (finasteride) to a hormone blockade. On the flip side, there are also many who are against adding these drugs.

Why are many oncologists reluctant to prescribe Avodart or Proscar?

The apparent reluctance is related to the lack of evidence that these medications are beneficial in this situation. The mainstay of treatment for recurrent or advanced prostate cancer is androgen deprivation therapy – suppression of the male hormones – by either surgically removing the testicles, or treatment with a gonadotropin-releasing hormone (GnRH) agonist such as leuprolide (Lupron, Eligard) or goserelin (Zoladex).

Actually, there is limited evidence that combination therapy with a GnRH agonist and an anti-androgen such as flutamide (Eulexin) or bicalutamide (Casodex)(ADT2) is better than a GnRH agonist alone. There have been no controlled studies to determine whether the drugs Avodart and Proscar are beneficial when added to the combined androgen blockade. Neither Avodart nor Proscar are FDA-approved to treat prostate cancer.

Other oncologists are against adding the third leg to the blockade because they are concerned that the Avodart and Proscar will artificially lower the PSA and mask any disease progression. Without a clean PSA measurement it will be very difficult to know when to restart the blockade.

The use of AT3 remains very controversial with men on both sides of the dispute who are passionate in their belief.

Joel T Nowak MA, MSW