For many years Proscar, now increasingly known by its generic name, Finasteride has been used to actually shrink the prostate to improve the flow of urine and avoid prostate surgery. More recently, Avodart, which is Dutasteride generically, was also approved by the FDA for the same purpose.
Patients often ask me to explain the differences between the two drugs. Both drugs work in a similar manner by preventing the conversion of testosterone, the male sex hormone into a sort of super male sex hormone called DHT for “Di-Hydro-Testosterone.” It’s DHT that makes the prostate grow. Urine must pass through the passageway in the prostate, which connects the bladder to the upper end of the urethra in the penis.
DHT makes glandular cells in the prostate grow in all directions, including inwardly, encroaching upon and putting pressure upon the urinary passageway running through the prostate. The conversion of testosterone to DHT occurs as a result of the effect of two chemicals, called enzymes, normally present in the body.
Proscar has the ability to interfere with the action of one of these enzymes, while Avodart interferes with both. Proscar reduces the concentration of DHT in the blood by about 70 percent whereas Avodart reduces it by over 93 percent. With both drugs, the blood levels of regular testosterone is increased by about 10 to 20 percent because the testosterone is not being used up as much as it normally would be by its conversion to DHT.
Both drugs result in shrinkage of the prostate’s glandular tissue and their side effect profiles are similar. Neither drug has been shown to adversely affect bone density. Both, after at least six months of use, will diminish PSA levels to about one-half of what they would have been without taking either Proscar or Avodart.
Since the ratio of free to total PSA is not affected by either drug, PSA free and total measurements can still be effectively used as a screening test for prostate cancer. The side effects of both drugs are similar, occurring in about 10 percent of men who have used the medications for a year and include decreased libido, impotence, decreased ejaculatory force and volume. Less frequently, uncomfortable breast enlargement may also occur.
Recent reporting of worldwide studies seems to indicate that the use of these drugs may actually reduce the overall incidence of the development of prostate cancer but when cancer does occur, it seems to be a more malignant type. I have found that a one-time non-surgical in-office microwave treatment of the prostate can relieve the annoying symptoms of prostate enlargement.
For men already taking Proscar or Avodart who would like to stop taking drugs, TherMatrx microwave thermotherapy, a safe, easily tolerated in office non-surgical treatment offers an excellent chance to get relief from both the prostate symptoms as well as from the drugs.
Have a Question? Call Dr. Okun at 718-241-6767