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Finasteride, a type II 5α-reductase inhibitor, lowers serum prostate-cancer antigen (PSA) levels in recipients. It is approved in the U.S. at two dosages: 5 mg daily (Proscar and generics) to slow progression and ease symptoms associated with benign prostatic hyperplasia, and 1 mg daily (Propecia) to manage male-pattern hair loss. The Prostate Cancer Prevention Trial demonstrated that daily high-dose finasteride (5 mg) for 7 years led to a 25% reduction in detectable prostate cancers (compared with rates in the general population) but a higher incidence of high-grade disease.
Evidence from randomized studies in which high-dose finasteride was compared with placebo showed that treatment for 48 weeks lowered serum PSA concentrations by approxi…