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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.
By inhibiting 5Î±-reductase, finasteride prevents conversion of testosterone to dihydrotestosterone (DHT) by the type II and III isoenzymes, resulting in a decrease in serum DHT levels by about 65â70% and in prostate DHT levels by up to 85â90%, where expression of the type II isoenzyme dominates.