Positive Role of Dutasteride in the Treatment of Localized Prostate Cancer

ABSTRACT

Dual inhibition of both 5AR1 and 5AR2 by dutasteride provides greater and more consistent inhibition of the conversion of testosterone to dihydrotestosterone (DHT) than selective inhibition of 5AR2 alone. Beyond the benefit of symptomatic improvement in lower urinary tract symptoms/benign prostatic hyperplasia by dutasteride, recently, several pioneering studies have shown cancer-protective roles of dutasteride in localized prostate cancer. This can be summarized into two categories: management of biochemical recurrence after radical therapy and management of active surveillance of low-risk prostate cancer. This review concerns the rationale and superiority of dutasteride as a cancer-protective agent in localized prostate cancer and its possible mechanisms, reinforced by two recent randomized controlled trials, the Avodart after radical therapy for prostate cancer study ("ARTS") and reduction by dutasteride of clinical progression events in expectant management ("REDEEM") studies.