Dear Dr. Roach: I am 65 and have been taking 5 mg of finasteride for over one year to address benign prostatic hyperplasia (BPH). My PSA score has lowered from 11.4 ng/mL (before finasteride) to 7.9 ng/mL, but I understand that this score should be doubled when taking finasteride. So, I think my PSA score has risen overall.
I have had two biopsies (the last in 2021); four MRIs (the last in March); two genetic tests (both indicated a 6% chance of having cancer); and 21 years of PSA scores, which slowly raised to 7.9 ng/mL (or 15.8 ng/mL if doubled). There is no prostate cancer in my family, although my maternal grandfather had it. It appears that my urologist’s diagnosis of BPH is, hopefully, correct.
As you can see, I am on top of my condition. I have viewed the medical literature on finasteride and wonder if my PSA score should really be doubled when taking it.
R.H.
Finasteride and dutasteride block the formation of a type of testosterone (DHT) that promotes prostate growth, so they shrink the prostate and reduce the likelihood of prostate cancer.
The PSA level decreases as a result of the downregulation of PSA gene expression. In most men, the first PSA score after starting finasteride is pretty close to half the number it was before starting.
Of course, the end result of cutting the PSA score in half is just an overall estimate, with some men having a larger drop and others having a smaller drop. I wouldn’t take the first number after starting finasteride too seriously, especially since your doctor has done a very extensive job by looking at your prostate.
The number that turns out to be very important is the next PSA level you get after being on finasteride for at least six months. If the second PSA score on finasteride goes up by more than 0.5 ng/mL, this is a red flag for prostate cancer. Most men will have a stable PSA level or a lowering of their PSA as the finasteride continues to work.
Finasteride and dutasteride decrease prostate cancer risk by about 25% to 50%. This is not high enough for me to recommend it to most men just to prevent prostate cancer, but it is reassuring when it is given to men with a symptomatic enlargement of the prostate.
Dear Dr. Roach: Does air conditioning affect arthritis?
J.S.B.
For any given person, air conditioning may make their arthritis symptoms better or worse. I have had many patients tell me that they feel stiffer after sleeping with air conditioning. I suspect it isn’t the temperature, so much as it is a change from the outside.
However, several studies have shown it is humidity that tends to bring on worsened symptoms in people with arthritis. So, air conditioning, which lowers humidity, might help some people with their arthritis symptoms.
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 [email protected]
