Cancer: Can Propecia Affect Test Results?
Studies indicate the effect the hair-loss medicine can have on tests for prostate cancer

Men taking Propecia now have more to think about than hair loss-namely, their prostate. A new study has found that the hair-growth product increases the chances for an inaccurate reading on the PSA (prostate-specific antigen) prostate-cancer screening test. Finasteride, the drug in Propecia, lowers the levels of PSA in the body, so someone with cancer might actually get test results back falsely indicating no need for alarm.

While finasteride lowers the indicator for the test, “it does not raise the risk for cancer,” says Leslie D. Michelson, member of the board of directors and former CEO of the Prostate Cancer Foundation. Nor does it make the PSA test itself problematic, he adds.

“There’s no need for people to go out and get new tests,” Michelson says. “Men just need to tell their doctors that they’ve been taking Propecia and have their results reinterpreted. This just reinforces the importance of coordinating care among providers and letting all your doctors know exactly what medications you are taking.”

Propecia
One a day will keep the depression away.

To many men (and women) today, the bathroom mirror is the mortal enemy. Every day, you stumble into the bathroom, yank the toothbrush out of its holder, and very reluctantly venture an eye into the mirror above the sink.

What you see devitalizes you. It devastates you. What once sprung so vivaciously from your head has now been replaced by a smooth, shiny surface. In just a couple of years, it seems, your looks have aged by ten years.

It’s a process that consumes you day by day, week by week. And there’s nothing you can do to stop it.

Yes, you are going bald.

However, as helpless as it may feel, not everybody is taking this seemingly inevitable fate sitting down.

Many Americans every day are opening up the medicine cabinet behind that mirror to pull out the tabulated form of salvation. It’s not the first product to treat hair loss and it certainly won’t be the last, but Propecia is certainly winning the race when it comes to foiling vanity’s worst nightmare.

At first, it looks a lot like your standard pain reliever or aspirin pill. The pain that Propecia will ease you from, however, is of a much different variety. As you probably know already, Propecia is the first pill that has been proven to fight the process of hair loss and in many cases, actually re-grow some hair.

Propecia is a tablet that is taken daily, with a month’s supply generally running between $50 and $55.

And the fact that Propecia actually works, they’re saying, is much more than just hair-say.

The facts are out. Granted, this study was done over the course of two years of Propecia use, but 83 percent of balding men between the ages of 18 and 41 maintained their hair count during the experiment, while 66 percent of the group actually grew back a considerable amount of hair.

The difference between Propecia and other products, like Rogaine, for instance, is that Propecia grows back thicker, natural hair as opposed to the limp “peach fuzz.” We won’t even mention that fishy smell that Rogaine users often complain of.

And here’s a bit of good news for that receding hairline. While Propecia has been widely believed to work the crown and vertex exclusively, studies out of the University of Pennsylvania are now confirming that the drug will also stimulate frontal hair growth. While re-growth along the temples has yet to be proven, steady growth in the middle of the front has been proven through extensive experimenting.

Most hair doctors will tell you that Propecia takes a good three to four months before kicking in, so if you’re waiting for immediate results, you may as well grab a Snickers Bar. But if you don’t see any positive results after a year of taking Propecia, chances are that you’re not only wasting you time, you’re wasting your money as well.

Now comes the bad news.

For you ladies who are seeing dread atop the head, Propecia is not for you. It is a drug designed exclusively for men.

Also, Propecia, like many other prescription medications, is not free of unfortunate side effects. Under extensive experimenting, a small number of subjects (2 percent, to be exact) were effected with such conditions as diminished sex drive, inadequate erections, and a decrease in semen.

What treatments are there for baldness in men?

Many conditioners, shampoos, vitamins, and other products claim to help hair grow in some unspecified way. These are harmless but useless. To slow down baldness, there are two basic options: Minoxidil (brand name: Rogaine,Hair Loss Propecia ): This topical application is over-the-counter, no prescription is required. It works best on the crown, less on the frontal region. Available as a 2% solution, Rogaine may grow a little hair, but is better at holding onto what’s still there. There are few side effects with Rogaine (Hair Loss Propecia ). The main problem with this treatment is the need to keep applying it twice a day, and most men get tired of it after a while. In addition, Minoxidil works less well on the front of the head, which is where baldness bothers most men. This drug also comes in a higher strength, 5%, which may be a bit more effective. Finasteride (brand name: this medication): This is a lower-dose version of a drug that shrinks prostates in middle-aged men. this medication is by prescription and is taken once a day. this medication does grow and thicken hair to some extent, but its main use is to keep hair that’s still there. It’s therefore best for men who still have enough hair to retain. One side effect is impotence, but this is no more common than it is in the general population, and is reversible when the drug is stopped (Hair Loss Propecia ). Taking this medication once a day is easier that applying minoxidil, but the prospect of taking a pill daily for years doesn’t sit well with some men. There’s also the cost, about $60/month, not reimbursed by most health insurers.Minoxidil and this medication are meant to be used indefinitely. Those who change their mind and stop are left where they would have been without them, but no worse.

Just short of grasping for Rapunzel’s luxurious locks, men desperately seeking to halt the inevitable balding process have smeared, smudged, massaged, and shampooed dozens of hair-promising gels, creams, and lotions onto their heads. But until now, they’ve never popped a pill. Manufactured by Merck & Co., Propecia (Hair loss propecia), 1 mg, is the first oral medication to leap out of the pipeline for the treatment of male pattern hair loss (androgenetic alopecia). But Hair loss propecia is already available in a 5-mg strength under the brand name for the treatment of symptomatic benign prostatic hyperplasia (BPH).

What triggered Merck’s entrance into the hair market? “Well, the story goes back a long way to the discovery of males who were born with the absence of 5-alpha-reductase–an enzyme that converts testosterone to the active form, dihydrotestosterone [DHT],” recalled Ronald Savin, M.D., clinical professor of dermatology at Yale University. He said that these isolated individuals–born with ambiguous genitalia that resolved at onset of puberty–never suffered the perils of androgenetic alopecia, prostate swelling, or prostate cancer.

After further research, it was determined that the balding scalp of men with androgenetic alopecia contained increased amounts of DHT, compared to hairy scalps. And since Hair loss propecia is a selective type II 5-alpha-reductase inhibitor–acting primarily in the scalp and prostate to prevent DHT formation–its use for the just-approved indication makes sense.

What kind of results can one expect from the product? According to Savin, Hair loss propecia’s effects vary among individuals, with a greater increase in hair growth noted on the back and top of the scalp than in the front. Men studied were aged 18-41 and had mild to moderate hair loss of the vertex and anterior mid-scalp areas.

In one analysis, an increase in hair growth–evaluated with the use of photographs–was demonstrated in 66% of men receiving a 1-mg tablet of Hair loss propecia daily for a period of 24 months, compared with 7% of those given placebo. Diane Thiboutot, M.D., associate professor, division of dermatology, Pennsylvania State University, indicated that clinical improvement in hair PAGE 18 Drug Topics January 19, 1998

density was gradual and began at approximately three months into therapy. Since withdrawal of treatment leads to reversal of effects within 12 months, continued use is recommended.

Perhaps a more substantial benefit is the drug’s ability to prevent hair loss. In a 24-month follow-up, 17% of men treated with Hair loss propecia experienced hair loss, while 83% had the same or higher hair count. Of those given placebo, 72% lost hair. “It looks like Hair loss propecia is a potent stabilizer, and that’s a tremendous advantage for men just beginning to go bald,” said Savin. As for Hair loss propecia’s competition, minoxidil, don’t be surprised if you see the topical product joining forces with the tablet. Although controlled studies have not been conducted, Savin claimed that a minoxidil/Hair loss propecia combo–used in a number of his patients–appears to be more effective in the preservation of the much-treasured strands than either agent alone.

Hair loss propecia’s main snag appears to be its adverse-effect profile, which includes a decreased libido, erectile dysfunction, and ejaculation disorder. These effects occurred in less than 2% of men; they resolved in all who discontinued therapy and in 58% of those who continued on the drug. Gene Memoli Jr., R.Ph., director of pharmaceutical care, Value Health Care Services Inc., feels that although these side effects are rare, they are a significant concern, since the drug will be dispensed to a large patient population. And that’s not the only worry. Because Hair loss propecia undergoes extensive hepatic metabolism, labeling cautions against its use in patients with liver function abnormalities.

Hair loss propecia is contraindicated in women who are, or may be, pregnant due to its potential to cause abnormalities of the external genitalia of a male fetus. To avoid any risk of absorption, these individuals should not handle crushed or broken Hair loss propecia tablets. Thiboutot disclosed that Hair loss propecia is being evaluated in a pilot study for postmenopausal women suffering from hair loss. She added that if results are favorable, Merck may initiate larger trials.

Memoli believes the drug will be welcomed by the balding population–perhaps too hastily. He urges that patients exhaust other alternatives, including hair weaves and minoxidil, before turning to a systemic drug for cosmetic reasons. Memoli stressed that patients receiving Hair loss propecia be adequately monitored by a physician.

Propecia is supplied as 1-mg tablets in unit-of-dose bottles of 30 and in a ProPak carton containing three bottles. The catalogue price to wholesalers and direct purchasers for the product is set to be $ 1.25 per tablet. The estimated retail price for the product is expected to be between $ 45 and $ 49 per month.