Increasing compliance with Active surveillance: A randomised trial evaluating the role of Finasteride

A 550-patient trial will test whether the drug finasteride can keep men with low-risk prostate cancer from dropping out of Active Surveillance—the strategy of monitoring the tumour rather than treating it immediately. Many men diagnosed with low or intermediate-risk prostate cancer choose Active Surveillance to avoid the side effects of surgery or radiation. Yet a significant number eventually abandon this approach, opting for treatment they may not need. The problem is that anxiety, rising PSA levels, or ambiguous biopsy results can push patients toward unnecessary intervention. This trial asks whether finasteride—a drug that shrinks the prostate and lowers PSA—can reduce those triggers and improve adherence. If finasteride proves effective, it could become a simple, low-cost tool to help thousands of men stay on Active Surveillance, sparing them from overtreatment and its lifelong consequences. The trial follows patients for an average of four years, tracking adherence, need for re-biopsy, and MRI findings. Success would shift clinical practice by adding a pharmacological support to a monitoring strategy that currently relies entirely on patient and clinician resolve.