To the Editor: Thank you for the excellent review on prostate cancer screening and prevention by Eric A. Klein, MD, in your August 2009 issue.
Dr. Klein concludes that the results of the Prostate Cancer Prevention Trial (PCPT) and the Reduction by Dutasteride of Prostate Events (REDUCE) trial were “congruent” with respect to the magnitude of prostate cancer risk prevention, beneficial effects on benign prostatic hypertrophy, and toxicity. In other words, finasteride and dutasteride produced equivalent clinical results with respect to prostate health despite the fact that dutasteride inhibits 5-alpha-reductase types 1 and 2, while finasteride inhibits only type 2.
Over the years, many patients have been prescribed dutasteride rather than finasteride because of hopes that the former might be more effective for maintaining prostate health. In August 2009, the retail price on Drugstore.com of a 90-day supply of generic finasteride is $190, vs $321 for dutasteride (which is available only as branded Avodart). In my experience as a practicing primary care physician, most patients would prefer to save money by switching to the less expensive generic drug if it provides equivalent prostate health outcomes compared with the more expensive branded drug.
I would like to ask Dr. Klein’s opinion on allowing patients to switch from Avodart to generic finasteride in order to save money, and on the general issue of which agent to use first-line for prostate health concerns.