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The Prostate Cancer Prevention Trial (PCPT) was designed to show whether finasteride (Proscar and generics), a 5α-reductase inhibitor, can prevent prostate cancer. At 7 years, finasteride, compared with placebo, was associated with lower overall risk for prostate cancer (18.4% vs. 24.4%), but with higher risk for high-grade cancers (6.4% vs. 5.1%; Journal Watch Jul 18 2003). Two new analyses of PCPT data suggest that these paradoxical results might be artifacts.
In one analysis, researchers (most of whom are employed by a manufacturer of finasteride) examined whether the increased rate of high-grade cancers reflected “sampling density bias.” They showed that the likelihood of detecting high-grade prostate cancer was inversely proportional to…