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Inside prostate cells, testosterone is converted by an enzyme named 5-reductase to dihydrotestosterone DHT ; , another androgen with pro-growth potency roughly 10 times as high as testosterone. 5-reductase inhibitors, which include finasteride Prozcar ; and dutasteride Avodart ; inhibit this enzyme, eliminating the production of DHT and thus reducing further the growth signals reaching prostate cells. These medications are highly effective in benign prostate enlargement, and might reduce the risk of developing prostate cancer. They have also been tested as treatments for established prostate cancer, as their side effect profile is milder than those of other ADT approaches. As single medications, they will reduce PSA but unlike other treatments they do not reduce the clinical burden of prostate cancer e.g., bone metastases ; . In combination with antiandrogens, however, they may offer similar efficacy as standard CAB, with less impact on sexual function, though the data supporting this approach remain preliminary. Table 1 summarizes the advantages and disadvantages of the various first approaches to hormonal therapy for prostate cancer.
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