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PROSCAR (FINASTERIDE): WARNINGS AND PRECAUTIONS
Effects on Prostate Specific Antigen (PSA) and the Use of PSA in Prostate Cancer Detection
In clinical studies, Proscar (Finasteride) reduced serum PSA concentration by approximately 50% within six months of treatment. This decrease is predictable over the entire range of PSA values in patients with symptomatic BPH, although it may vary in individuals.
For interpretation of serial PSAs in men taking Proscar (Finasteride) tablets, a new PSA baseline should be established at least six months after starting treatment and PSA monitored periodically thereafter. Any confirmed increase from the lowest PSA value while on Proscar may signal the presence of prostate cancer and should be evaluated, even if PSA levels are still within the normal range for men not taking a 5-alpha-reductase inhibitor. Non-compliance with Proscar tablets therapy may also affect PSA test results. To interpret an isolated PSA value in patients treated with Finasteride (Proscar) for six months or more, PSA values should be doubled for comparison with normal ranges in untreated men. These adjustments preserve the utility of PSA to detect prostate cancer in men treated with Finasteride (Proscar) 5 mg tablets.
Proscar (Finasteride) may also cause decreases in serum PSA in the presence of prostate cancer.
The ratio of free to total PSA (percent free PSA) remains constant even under the influence of Finasteride (Proscar) tablets. If clinicians elect to use percent free PSA as an aid in the detection of prostate cancer in men undergoing finasteride therapy, no adjustment to its value appears necessary.
Increased Risk of High-Grade Prostate Cancer
Men aged 55 and over with a normal digital rectal examination and PSA <= 3.0 ng/mL at baseline taking finasteride 5 mg/day in the 7-year Prostate Cancer Prevention Trial (PCPT) had an increased risk of Gleason score 8-10 prostate cancer (finasteride 1.8% vs placebo 1.1%). Similar results were observed in a 4-year placebo-controlled clinical trial with another 5-alpha-reductase inhibitor (Dutasteride, Avodart) (1% dutasteride vs 0.5% placebo). 5-alpha-reductase inhibitors may increase the risk of development of high-grade prostate cancer. Whether the effect of 5-alpha-reductase inhibitors to reduce prostate volume, or study-related factors, impacted the results of these studies has not been established.
Evaluation for Other Urological Conditions
Prior to initiating therapy with Finasteride (Proscar), appropriate evaluation should be performed to identify other conditions such as infection, prostate cancer, stricture disease, hypotonic bladder or other neurogenic disorders that might mimic BPH.
Patients with large residual urinary volume and/or severely diminished urinary flow should be carefully monitored for obstructive uropathy. These patients may not be candidates for finasteride therapy.
Exposure of Women - Risk to Male Fetus
Women should not handle crushed or broken Proscar (Finasteride) 5 mg tablets when they are pregnant or may potentially be pregnant because of the possibility of absorption of finasteride and the subsequent potential risk to a male fetus. Proscar (Finasteride) tablets are coated and will prevent contact with the active ingredient during normal handling, provided that the tablets have not been broken or crushed.
Pediatric Patients and Women
Proscar (Finasteride) tablets are not indicated for use in pediatric patients or women.
Effect on Semen Characteristics
Treatment with Proscar for 24 weeks to evaluate semen parameters in healthy male volunteers revealed no clinically meaningful effects on sperm concentration, mobility, morphology, or pH. A 0.6 mL (22.1%) median decrease in ejaculate volume with a concomitant reduction in total sperm per ejaculate was observed. These parameters remained within the normal range and were reversible upon discontinuation of therapy with an average time to return to baseline of 84 weeks.
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