Urologists disagree on finasteride for an enlarged prostate

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 totally blocked urethra. I was sent home from the emergency room with a two-week catheter. My urologist prescribed 5 mg of finasteride and alfuzosin.I spend winters in Florida, but my urologist in Florida says not to use finasteride, since it doesn't work. I am stuck in the middle now with my prescription. What is your professional opinion on taking finasteride? — D.T.Answer: Your urologist in Florida is being overly dogmatic. The studies clearly show that finasteride (Proscar), like its cousin dutasteride (Avodart), are effective at treating an enlarged prostate. There is strong evidence that they shrink the prostate, slow progression of prostate enlargement, improve symptoms, and reduce the need for surgery, all of which are good things. Furthermore, they also reduce the risk of prostate cancer with estimates of a 25% to 50% decreased relative risk in developing prostate cancer.What is true and what the urologist may really mean is that these drugs work very slowly. You'll get about half the benefit you'll ever get after six months of treatment. This is in sharp contrast to alpha blockers like alfuzosin, which work well the day you take them.Many urologists will prescribe both classes of medicine to men who have a high risk of not responding to alpha blockers alone. The fact that you had total obstruction seems to support the prescription of finasteride, and the sooner you start it, the quicker it becomes effective. This decision takes clinical judgment, but the data generally support your first urologist's decision.Dear Dr. Roach: During the past couple of weeks, there have been numerous articles in the news about getting rid of black utensils due to flame retardant and other chemicals. It says that 85% of black utensils and pans may have this problem. My husband and I are in our early 80s and have good health. Is this really something to worry about? — E.M.Answer: A study was published in October showing that many household products made of black plastic 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 have health concerns, such as possibly increasing the risk of cancer, disrupting hormones, and potentially causing developmental defects in children. These chemicals have largely been banned, but they continue to be recycled and reused. The study does not give an estimate of how large the risk might be, but the levels they found are certainly in excess of what is recommended.I often see studies where there is a negligible risk that is blown out of proportion by the press. This may be similar. However, since it isn't hard to reduce risk, it's reasonable to replace black plastic products you use every day with something safer like metal, wood, bamboo or silicone. I did.Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.