Some commonly used BPH drugs called 5-alpha-reductase inhibitors — including finasteride (Proscar) — decrease the size of the prostate, and have a U.S. Food and Drug Administration drug safety warning because they have been found to increase the risk of high-grade prostate cancer, Nandalur noted.
“Our study finds a potential explanation for the findings, as decreasing the prostate size with these drugs may lead to decreased pressure throughout the gland and possibly allow cancer to grow. These are very useful drugs to treat BPH, but care should be taken,” Nandalur said.
Dr. Anthony D’Amico, a professor of radiation oncology at Harvard Medical School in Boston, said that he would take these study results with a grain of salt.
“I would approach this with extreme caution,” D’Amico said.
These findings could result because BPH makes cancer harder to find with a biopsy, D’Amico said. “BPH could make it harder to find cancer because your needle is now going into a much smaller area. So I think it’s interesting, there may be something there, but certainly not something that I would call conclusive at this time,” he explained.
The findings may, however, have a biological explanation, he said. “If you have a lot of BPH, that’s competing with prostate cancer for growth factor, maybe the prostate cancer gets a growth disadvantage,” D’Amico said. “That’s a biological premise, but it’s not been proven.”
D’Amico advises men with BPH to have an MRI and biopsy to be sure there isn’t cancer.
“If you have a large prostate I would not assume that any prostate cancer you have is going to be clinically insignificant. You should still have an MRI and a fusion biopsy to rule out clinically significant disease,” he said. “This study is interesting, but not conclusive.”
The report was published online Aug. 10 in the journal The Prostate.
For more on prostate cancer, head to the American Cancer Society.
SOURCES: Kiran Nandalur, MD, vice chief, diagnostic radiology and molecular imaging, Beaumont Hospital, Royal Oak, Mich.; Anthony D’Amico, MD, PhD, professor, radiation oncology, Harvard Medical School, Boston; The Prostate, Aug. 10, 2021, online