"This report may influence me to tell younger patients with a PSA of three or less with no symptoms that there is a drug that may decrease the risk of developing prostate cancer. That's the upside.

The downside is, it's a pill you have to take every day for the rest of your life and you have to pay for it. My patient population has double-digit unemployment in a rural area, and many come in for samples because they can't afford their drugs. So that may not be realistic.

I'll be watching the studies as I approach that magic age of 50."

"It's very interesting information. I would like more time to digest the information and see if it holds up, but I certainly want to make my patients aware they have the option. I haven't seen much in the way of negative effects from either Proscar or Avodart.

The negatives are cost considerations with the risk of reduction of about 25%. If you look at it from a cost-benefit [standpoint], it's not as much of a home run as you might want from an ideal cancer preventive. I would like to see if this study is repeated and additional supporting information comes down."

Eric Seaman, MD
West Orange, NJ

"I think the study is going to influence people a lot.

I've used the drugs in a select group as cancer prevention: those with an elevated PSA with negative biopsy, but with prostatic intraepithelial neoplasia (PIN) in it. Now the question is whether we should extend that to people with elevated PSAs with benign biopsies. If that's the case, that will extend the indications significantly. I'm not really comfortable with that.

We worry about patients with PIN biopsies because PIN is a precursor for cancer. So it really isn't a problem using finasteride on patients with PIN. But if there's no PIN, I'm uncomfortable starting a younger patient on a chronic medication. That would be a dramatic shift in our treatment paradigm."

Craig Zippe, MD
Bedford, OH

"I've been telling people who are at high risk of developing cancer about the 5-ARIs, but not specifically as cancer prevention. I'm not planning to expand that criteria because I would like more time lapse showing the efficacy of the drug. Also, any medication has side effects, as well as cost, and if people do develop cancer, there is a risk that the disease could be more aggressive or microscopically different if they are on the medication.

I have seen PSA numbers decrease in 6 months of taking these medications, and that makes me feel that the PSA elevation was due to benign disease, rather than cancer. I've been able to save patients unnecessary repeated biopsies."

Elias F.H. Tanabe, MD"
Pittsburg, KS

Editor's note: Interviews for this article were conducted prior to the release of data from the the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) trial, which showed a 23% risk reduction in prostate cancer among men treated with dutasteride (Avodart).