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Finasteride reduces PSA levels to varying degrees in different men, making it difficult to track what the âtrueâ PSA values are over time. Finasteride fails to reduce PSA velocity (increases) in men with high-grade prostate cancer and fails to induce objective responses in men with metastases. Finasterideâs so-called âpreventiveâ effects in the Prostate Cancer Prevention Trial occurred far too early and did not increase much over time.
The effects of finasteride on PSA have been studied in several cohorts of men with symptomatic BPH. 11â13 Initial results indicated that finasteride causes an average 50% decrease in PSA by 1 year following the initiation of treatment. 11 This 50% decrease also appeared to apply at the individual level, leading to the multiply by 2 rule, which recommends that PSA in men on finasteride should be doubled before being compared with standard reference ranges.