What does plastic surgery have to do with reducing the risk of cancer? We all think of plastic surgery as allowing one to look younger, but can plastic surgery treatment cause a person to live longer? The answer is, “Yes, in some cases!!” For instance, breast reduction surgery does decrease the risk of a woman developing breast cancer. I have also had several patients who underwent breast reduction and were found to have a breast cancer in the breast tissue removed, possibly extending the life of these women. Along those lines, a recent study published in this week’s New England Journal of Medicine raises the question of whether Propecia, a medication given to treat and prevent male pattern baldness, decreases the risk of prostate cancer?
A study begun 20 years ago – named the Prostate Cancer Prevention Trial (PCPT) – looked at the question of whether the drug finasteride (5 mg dose) could prevent prostate cancer in men ages 55 and older? Propecia is finasteride, but in a 1 mg dose. Half of the men were given 5mg of finasteride daily and the other half were given a placebo, basically a “sugar pill” that looked and tasted like finasteride. Before a man could join the study, he underwent a physical exam and blood test to make certain that he had no signs of prostate cancer. After joining the study, these tests were repeated every year. At the end of 7 years in the study, each participant who had not been diagnosed with prostate cancer was asked to have a prostate biopsy and these biopsies were checked for any signs of cancer.
Why would such a study be done? Finasteride is used to shrink enlarged prostate glands in men who are having symptoms such as difficulty with urination. It works by reducing the level of dihydrotestosterone (DHT) in the blood and in the prostate gland. DHT causes enlargement of the prostate gland by promoting the growth of prostate cells. Reducing its level shrinks prostate gland size. The development of prostate cancer is also strongly influenced by male hormones and a reduction in DHT levels might prevent the development of prostate cancer.
DHT also causes the shrinkage of the hair follicle, leading to male pattern baldness. That is why Propecia, a 1mg dose of finasteride, is used to treat male pattern baldness.
What were the study results?
• Men who took finasteride developed 30% fewer prostate cancers. These were low-grade prostate cancers, meaning that the cancers tend to be slower growing and are less likely to grow beyond the prostate gland.
• High-grade prostate cancers occurred at the same rate in both the men who took finasteride and those who took the placebo.
• Finasteride also improves the detection of prostate cancers because it shrinks the size of the gland, increasing the chance that a prostate biopsy will find existing cancers.
• Finasteride reduces the chances of a man developing certain changes in the cells of the prostate gland called PIN (high-grade prostatic intraepithelial neoplasia). The rate at which these changes were reduced is about the same as the rate at which finasteride reduced the risk of prostate cancer, suggesting that this may be the mechanism of action for finasteride.
Would these same results be found in men who take Propecia for treatment of hair loss, given that it is only 1/5th as strong as the finasteride given to the men in the study? We don’t know the answer to this.
Let me hasten to add that at this time, finasteride is not approved by the U.S. Food and Drug Administration (FDA) for the prevention of prostate cancer.
Please feel free to leave a comment. You may also contact my Los Angeles plastic surgery office office for any other questions.
George Sanders, M.D.