Change in PSA Concentration in Men with PSA Less than 2.5 ng/ml Taking Low Dose Finasteride or Dutasteride for Male Androgenetic Alopecia

Androgenetic alopecia is an androgen-induced pattern of progressive hair loss that involves the local and systemic conversion of testosterone to dihydrotestosterone via the enzyme 5a-reductase (5aR)¹. Two medical treatments are currently known to treat hair loss in these men: finasteride and dutasteride; both of which inhibit 5aR type 2, the predominant form of 5aR in benign prostatic tissue^2,3. Randomized studies testing the high doses of finasteride, common for the treatment of benign prostatic hyperplasia (BPH), and placebo have shown that a 48-week regimen of the drug lowered serum prostate-specific antigen (PSA) concentrations by approximately 50%⁴. Similarly, low doses of finasteride, common for the treatment of androgenetic alopecia, has also been shown to lower PSA concentrations by 50% in men aged 50-60 years old⁵. The primary aim of this study was to investigate and validate the effect of low-dose finasteride and dutasteride on PSA levels of men with androgenetic alopecia with baseline serum PSA less than 2.5 ng/ml.

This study retrospectively obtained information from 1,379 male patients who were treated for androgenetic alopecia at the dermatology clinic at the Chungbuk National University Hospital between January 2002 and December 2012. All patients were treated with either 1.25 mg of finasteride orally once daily or 0.5 mg of dutasteride orally every 3 days. Patients remained eligible if PSA was measured before and at least once at least 3 months after starting 5aR inhibitor (5aRI) treatment. Patients were excluded if their baseline PSA value was greater than 2.5 ng/ml.

Overall, the low dose 5aRI reduced PSA by 27.8% relative to baseline. Of the 1,279 patients, 1,094 (79.3%) showed a decrease in PSA. The average reduction of PSA was 40.8%. Patients 50 or greater experienced an average of 30.6% lower PSA value compared to baseline. Men who were treated with dutasteride or finasteride were found to have a reduced PSA level of 31.1% or 25.1% compared to baseline, respectively. The duration of medication did not influence the reduction in PSA. Patients who were treated with medication for 3–5 months experienced a similar reduction in PSA from baseline as patients treated for 36 or more months. In patients who had a baseline PSA of less than 0.5 ng/ml, the reduction of PSA level was only 1.8%.

In conclusion, it was found that low-dose dutasteride and finasteride treatment for androgenetic alopecia reduced PSA to a similar extent. These results were observed after a short treatment period but didn’t vary much over time. In addition, patients with low baseline PSA (less than 0.5 ng/ml) did not show a reduction of PSA.

Written by: Zhamshid Okhunov, MD, University of California Irvine

References:
1. Trueb RM: Molecular mechanisms of androgenetic alopecia. Exp Gerontol 2002; 37: 981.
2. Kapadia N, Ahmad TJ and Borhany T: Male androgenetic alopecia treated with finasteride. J Pak Assoc Dermatol 2016; 18: 232.
3. Shanshanwal SJ and Dhurat RS: Superiority of dutasteride over finasteride in hair regrowth and reversal of miniaturization in men with androgenetic alopecia: a randomized controlled open-label, evaluator-blinded study. Indian J Dermatol Venereol Leprol 2017; 83: 47.
4. Etzioni RD, Howlader N, Shaw PA et al: Long-term effects of finasteride on prostate specific antigen levels: results from the Prostate Cancer Prevention Trial. J Urol 2005; 174: 877.
5. D’Amico AV and Roehrborn CG: Effect of 1 mg/day finasteride on concentrations of serum prostate-specific antigen in men with androgenic alopecia: a randomised controlled trial. Lancet Oncol 2007; 8: 21.

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