Proscar is receiving a lot of attention as a possible solution to prostate problems. Manufactured by Merck and Co., Inc., it is genetically known as Finasteride. The story behind the development of Proscar is fascinating and almost reads like a Hollywood film script. Scientists at Merck had made a commitment to develop a drug to treat the symptoms of BPH as early as 1966. Apian was put into action to study endocrine approaches to BPH. The initial plan was to focus on the development of antiantigen or antiprogesterone agents to help interrupt the growth of the prostate.

By the end of the decade, it was generally believed that DHT, rather than testosterone, was the key hormone involved in the growth of the prostate gland, and 5-alpha reductase, the enzyme that catalyzes the conversion of testosterone to DHT, had been described. At this time, scientists began to consider reorienting their prior research to focus on DHT-antagonists (DHT-inhibitors) and on 5-alpha reductase.

Then the plot thickened. Scientists observed a group of males on a small Caribbean island who had a congenital deficiency of 5-alpha reductase at birth and were raised as girls. But at puberty they started to develop male genitals, hair on the face and other parts of the body, and an interest in females. The adult males who had genetically inhibited 5-alpha reductase showed decreased levels of DHT, had small prostate glands, and—most significantly—did not develop BPH. They also did not have normal beard growth, acne, or chronological hair growth.

Based on these findings, it was theorized that a specific inhibitor of 5-alpha reductase might have the potential to shrink an enlarged prostate without affecting testosterone-dependent functions or causing other adverse reactions.

You can just imagine the excitement this revelation must have caused for the investigators at Merck research laboratories. Scientists pursued the development of inhibitors to 5-alpha reductase and developed a class that would show the growth of the prostate.

One of these compounds, Finasteride, was found to be effective in treating enlarged prostates in dogs, and it was later used on humans. Trials of Finasteride began in 1986, and it was approved by the FDA in 1992. Will this be the magic bullet that will end so much suffering and pain among so many American males? It could very well be, but as with many drugs, it does have a downside. A major drawback to the use of Proscar is that it takes about three months before the prostate shrinks enough to help in urinary flow problems, and for the prostate sufferer this can seem like a lifetime.

Proscar also reduces a man's level of prostate-specific antigen (PSA); a low value usually indicates that a man is less likely to have cancer than men with higher levels. But when the PSA level has been reduced by Proscar, it complicates the diagnosis. According to Jerome P. Pichie, Profess' of Surgery at Harvard and Chief of Urology at Brigham and Women's Hospital, "Men should have a PSA test before starting Proscar and another one three to six months later." If a man's PSA levels have not dropped by one-third to one-half after taking the drug for several months, this may signal the presence of prostate cancer or another problem. In this case, a urologist should be consulted to investigate further.

An article in the April 12, 1995, issue of The Wall Street Journal quoted a representative of Merck and Co., Inc., as saying, "Proscar may grow hair on bald men's heads, so if it doesn't prove to be the wonder drug for shrinking the prostate, the investment in the drug may still be profitable." Merck has high hopes for this drug and expects it to generate a billion-dollar profit.

An article in The American Druggist lists the pros and cons of taking Proscar. The one advantage listed is:

Improvement of symptoms: After one year, symptoms improve to some degree in 63 percent of men.

The three disadvantages listed are:

Slow action: Patients may have to wait six months to a year for the drug to work.

Impotence: Within one year, 4 percent of men have some trouble having an erection.

Decreased ejaculate: Within a year, 3 percent of men have a decrease in semen produced.

Although preliminary results look favorable, investigators will have to look at the long-term effect of this medication as it relates to the prostate and its effect on the development of prostate cancer.