Health and Prostate

Question: How many benign prostatic hyperplasia (BPH) sufferers could benefit from finasteride (Proscar)? Which factors determine who should receive it?

Answer: This comes down to the question of who is a good responder, and what is a good response. Is it complete abolition of symptoms or just a 50% improvement, enough to make the patient feel just like a normal elderly man? The degree of prostate gland enlargement is the key factor that predicts outcome of treatment. We performed a meta-analysis, pooling the results from similar trials, so we now have data from over 4,000 patients. This analysis clearly showed that men with more enlarged prostates, over 40 g, have a more significant benefit from the drug. The mean size of the prostates in our study was about 41 g, meaning half the men had prostates larger than that, and half smaller. In our estimation, about 40% of patients have the best effect from the drug, significantly better than reported in the trial. About 20% dropped out over the two years of the study, and the main reason was lack of expected efficacy. If you use the principle “intention to treat”, which means including results from every patient initially enrolled in a study, you get a true picture of what happens to the whole population you treat. It actually diminishes the end results, but it’s regarded as state of the art statistics. The intention is to see in a large group of patients what happens to the whole group, whether they stay in the trial or drop out.