Prostate cancer prevention: do the 5-ARIs make the grade?

Although imperfect, PSA testing is here to stay. Men who undergo PSA testing should do so with an understanding of the potential benefits (decreased prostate cancer mortality) and known risks (increased likelihood of being diagnosed with prostate cancer) of screening. The diagnosis of prostate cancer often leads to radical therapy in men who would never have known they had the disease if not for early detection. Although it is possible that 5-ARIs may occasionally cause a high-grade prostate cancer, the magnitude of this potential harm is likely to be tempered by earlier detection. Also balancing this potential harm is the well-established fact that the 5-ARIs decrease the likelihood that a man who desires PSA testing will become a prostate cancer patient. These are admittedly difficult risk–risk calculations. However, to suggest that only “unambiguously safe” drugs should be approved for cancer risk reduction sets a standard that can only be met by homeopathic nostrums. That is not the standard to which we should aspire.