Ho ritrovato questo prospettiva clinica sull'utilizzo di fina come prevenzione per il cancro prostatico che poi dimostrò un decremento di quelli a basso grado in contemporanea all'aumento di quelli di alto grado. Da qui si postulò la ragionevolezza di evitarne l'utilizzo come prevenzione ma di utilizzarlo solo come cura per l'ipertrofia prostatica calcolando il rapporto rischio - beneficio
Il problema che l'articolo solleva è piuttosto come avvisare gli utilizzatori di fina 1 mg sul rapporto rischio beneficio sulla base di un quasi identico effetto di dosi da 1mg e da 5mg sul serum DHT and testosterone, prostatic DHT and testosterone, scalp dht
(insomma propecia1mg = proscar5mg per quanto sopra)
In un ulteriore studio successivo si è cmq evidenziato un livello diverso di dht nella prostata
Le tabelle A e B evidenziano le minime differenze anche con più alte dosi di fina
Although the issue of using Proscar to treat BPH has been
addressed, there remains the question of how to advise patients who take Propecia (finasteride, 1 mg) for the treatment
of baldness. This concern was not raised in the article itself,
in the NEJM editorial, in the discussion in the JNCI, or in the
correspondence in the October issue of the NEJM. This is a
most significant oversight because the effects of 1 and 5 mg
of finasteride result in more or less equal changes in serum
DHT and testosterone (Refs. 18 and 19 and Fig. 1A), prostatic
DHT and testosterone (Ref. 19 Fig. 1B), and scalp DHT (Refs.
18 and 20 and Fig. 1C). A subsequent study (21) confirmed
the lack of difference in blood, but found a significantly
greater fall in prostate DHT for the 5-mg than the 1-mg dose
(placebo, 18.6 nmol/kg; 1 mg, 3.8 nmol/kg; 5 mg, 1.0 nmol/
kg; P 0.049 between the two doses of finasteride) after 6 – 8
wk of treatment.
Si presume così che gli effetti a lungo termine di dosi di fina 1 mg e 5mg non differiscono
(in questo articolo si parla però del solo rischio di cancro prostatico)
Thus, at least for purposes of this discussion, it is
both conservative and reasonable to presume that the long
term effects of 1 and 5 mg finasteride, in regard to prostate
cancer, will not differ
le relazioni non sono cmq ancora chiarissime.
In ogni caso per l'ipertrofia prostatica vale la pena rischiare, più dubbioso è farlo per l'aga. Non v'è aperta discussione su questo punto
For the moment anyway, it appears that the benefits of therapy with finasteride for BPH are probably worth the risk. Second, and more problematic, is the fact that there has been no open discussion of the potential danger in the long-term use of Propecia.
Bear in mind that the treatment of alopecia with finasteride is a lifelong commitment and that “lifelong’” means
a long time for young men. Will these patients be protected
from prostate cancer, or are they at greater risk of serious
disease? Whatever the answer, because of the prospect of
many years of use, there should be a sense of urgency in
sorting out this dilemma. In the interim, physicians and their
patients should at least be aware of the potential risks and
together should evaluate the use of Propecia for baldness. For
my part, I will stay with the tried and true, “first do no harm.”
http://jcem.endojournals.org/content/89/7/3096.full.pdf
Il problema che l'articolo solleva è piuttosto come avvisare gli utilizzatori di fina 1 mg sul rapporto rischio beneficio sulla base di un quasi identico effetto di dosi da 1mg e da 5mg sul serum DHT and testosterone, prostatic DHT and testosterone, scalp dht
(insomma propecia1mg = proscar5mg per quanto sopra)
In un ulteriore studio successivo si è cmq evidenziato un livello diverso di dht nella prostata
Le tabelle A e B evidenziano le minime differenze anche con più alte dosi di fina
Although the issue of using Proscar to treat BPH has been
addressed, there remains the question of how to advise patients who take Propecia (finasteride, 1 mg) for the treatment
of baldness. This concern was not raised in the article itself,
in the NEJM editorial, in the discussion in the JNCI, or in the
correspondence in the October issue of the NEJM. This is a
most significant oversight because the effects of 1 and 5 mg
of finasteride result in more or less equal changes in serum
DHT and testosterone (Refs. 18 and 19 and Fig. 1A), prostatic
DHT and testosterone (Ref. 19 Fig. 1B), and scalp DHT (Refs.
18 and 20 and Fig. 1C). A subsequent study (21) confirmed
the lack of difference in blood, but found a significantly
greater fall in prostate DHT for the 5-mg than the 1-mg dose
(placebo, 18.6 nmol/kg; 1 mg, 3.8 nmol/kg; 5 mg, 1.0 nmol/
kg; P 0.049 between the two doses of finasteride) after 6 – 8
wk of treatment.
Si presume così che gli effetti a lungo termine di dosi di fina 1 mg e 5mg non differiscono
(in questo articolo si parla però del solo rischio di cancro prostatico)
Thus, at least for purposes of this discussion, it is
both conservative and reasonable to presume that the long
term effects of 1 and 5 mg finasteride, in regard to prostate
cancer, will not differ
le relazioni non sono cmq ancora chiarissime.
In ogni caso per l'ipertrofia prostatica vale la pena rischiare, più dubbioso è farlo per l'aga. Non v'è aperta discussione su questo punto
For the moment anyway, it appears that the benefits of therapy with finasteride for BPH are probably worth the risk. Second, and more problematic, is the fact that there has been no open discussion of the potential danger in the long-term use of Propecia.
Bear in mind that the treatment of alopecia with finasteride is a lifelong commitment and that “lifelong’” means
a long time for young men. Will these patients be protected
from prostate cancer, or are they at greater risk of serious
disease? Whatever the answer, because of the prospect of
many years of use, there should be a sense of urgency in
sorting out this dilemma. In the interim, physicians and their
patients should at least be aware of the potential risks and
together should evaluate the use of Propecia for baldness. For
my part, I will stay with the tried and true, “first do no harm.”
http://jcem.endojournals.org/content/89/7/3096.full.pdf