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    • Urologists disagree on finasteride for enlarged prostate
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    Urologists disagree on finasteride for enlarged prostate

    Pabio Posted on

    Dr. Keith Roach
    | To your health

    Dear Dr. Roach: I was diagnosed with an enlarged prostate two months ago. I thought it was another kidney stone I needed to pass, but I had a completely blocked urethra. I was sent home from the emergency room with a two-week catheter. My urologist prescribed me 5 mg of finasteride and alfuzosin.

    I spend my winters in Florida, but my urologist in Florida tells me not to use finasteride because it doesn’t work. I’m stuck in the middle now with my prescription. What is your professional opinion on taking finasteride?

    —DT

    Dear DT: Your urologist in Florida is too dogmatic. Studies clearly show that finasteride (Proscar), like its cousin dutasteride (Avodart), are effective in treating an enlarged prostate. There is strong evidence that they shrink the prostate, slow the progression of enlarged prostate, improve symptoms, and reduce the need for surgery, which are all good things. Additionally, they also reduce the risk of prostate cancer, with an estimated 25-50% decrease in the relative risk of developing prostate cancer.

    What is true and what the urologist can actually tell is that these medications work very slowly. You will get about half the benefit you will after six months of treatment. This is in stark contrast to alpha blockers like alfuzosin, which work well on the day you take them.

    Many urologists prescribe both classes of drugs to men who are at high risk of not responding to alpha blockers alone. The fact that you have complete obstruction seems to warrant prescribing finasteride, and the sooner you start it, the sooner it will become effective. This decision is a matter of clinical judgment, but the data generally supports your initial urologist’s decision.

    Dear Dr. Roach, Over the past few weeks, there have been numerous articles in the media about the elimination of black utensils due to flame retardants and other chemicals. It states that 85% of black utensils and pans can have this problem. My husband and I are in our early 80s and in good health. Is this really something to worry about?

    —EM

    Dear EM: A study published in October shows that many black plastic household products are contaminated with flame retardants. The authors noted that these are often made from recycled materials, some of which contain large amounts of flame retardant chemicals.

    Some of these chemicals pose health concerns, such as possible increased risk of cancer, disruption of hormones, and possible developmental abnormality in children. These chemicals have been widely banned, but they continue to be recycled and reused. The study does not provide an estimate of the magnitude of the risk, but the levels found are certainly higher than those recommended.

    I often see studies where there is a negligible risk that is wildly exaggerated by the press. It may be similar. However, since it is not difficult to reduce risks, it is reasonable to replace the black plastic products you use daily with something safer like metal, wood, bamboo or silicone. I did it.

    Readers can email questions to [email protected].

    Pabio
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