See the doctor next week and need help!

[Guest guest]

My journey (nightmare) with PC continues. I have an appointment to talk with the doctor next week about treatment for my PC. I had one positive sample and 11 negative from the biopsy. Gleason score of 7. I am guessing the doctor is going to recommmend removing the prostate. PSA was 4 and DRE is normal. I took propecia (finasteride) for 10 years for my hair loss. From the National Institute of Health:

The Prostate Cancer Prevention Trial (PCPT) demonstrated a 24.8%

reduction in the 7-year prevalence of prostate cancer among patients

treated with finasteride (5 mg daily) compared with that among

patients treated with placebo; however, a 25.5% increase in the

prevalence of high-Gleason grade tumors was observed, the clinical

significance of which is unknown. One hypothesized explanation for

this increase is that finasteride reduced prostate volume, leading to

detection of more high-grade tumors due to increased sampling

density. This possibility was investigated in an observational

reanalysis of the PCPT data, with adjustment for sampling density.

Median prostate volume was 25% lower in the finasteride group (median

= 25.1 cm3) than in the placebo group (median = 33.5 cm3). Later studies showed finasteride does not cause increases in high grade PC and actually reduces the risk of developing PC!!! The orginal studies that showed more high grade PC was caused by the reduced size of the prostate in mem taking finasteride.

I called the doctors office and ask for a copy of the pathology report. I will read it and try to make some sense of it. I am worried the use of finasteride has changed my Gleason score and made it higher. I sent a letter to the doctor requesting the samples be sent to a Dr Epstein at Hopkins for a second opinion. My question is: Why does the reduced volume of my prostate make my Gleason score higher? Thanks to anyone who can help. Chuck