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Finasteride Use Up in VHA System but Not for Prevention

Unrelated to '03 study results; urologists reluctant to prescribe for prostate cancer prevention

TUESDAY, Aug. 10 (HealthDay News) -- Finasteride prescriptions in the Veterans Health Administration (VHA) increased between 2000 and 2005, but the increase probably was not due to doctors prescribing it for prostate cancer chemoprevention, according to research published online Aug. 10 in Cancer Epidemiology, Biomarkers & Prevention.

Robert J. Hamilton, M.D., of the Duke University School of Medicine in Durham, N.C., and colleagues conducted a survey on trends in finasteride prescribing in the VHA system to determine whether prescribing was related to publication of the Prostate Cancer Prevention Trial (PCPT) in 2003. This trial demonstrated a reduction in prostate cancer risk in men in the finasteride arm of the study. The researchers also collected data regarding use of finasteride among primary care physicians (PCPs) and urologists in the VHA.

Although the number of men started on finasteride during the study period increased, the investigators found that publication of the PCPT was not associated with any change in the prescribing patterns (P = 0.45). Both PCPs (40 percent) and urologists (57 percent) reported prescribing finasteride more frequently in 2006 than they had five years ago, but of those who changed their prescribing patterns, fewer than 2 percent in each group ascribed their changes to the PCPT study. The majority of physicians stated that they never prescribe finasteride for chemoprevention (80 percent of PCPs and 64 percent of urologists), often due to a lack of awareness that finasteride could be used for chemoprevention (PCPs), and concerns about inducing high-grade prostate cancers (urologists).

"For prostate cancer, greater use of 5-α reductase inhibitors for chemoprevention will likely require increased awareness among PCPs, acceptance by urologists of the new evidence disputing the risk of high-grade disease, and greater interest among men who might benefit from taking it," the authors write.

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