Objective
To review the efficacy of treating benign prostatic hyperplasia and very-low-risk
prostate cancer (PCa) in patients receiving active surveillance and 5α-reductase inhibitor
(5-ARI; finasteride or dutasteride) treatment.
Materials and Methods
Eighty-two men with very-low-risk PCa (clinical stage T1c, Gleason score ≤6, <3 biopsy
cores positive with ≤50% involvement, and prostate-specific antigen density ≤0.15
ng/mL/g) and benign prostatic hyperplasia (≥30 cm3) received active surveillance and were treated with a 5-ARI.
Results
All 82 men completed 1 year of 5-ARI therapy (n = 79) or underwent early biopsy for
cause (n = 3). Restaging biopsies were performed for 76 men (22 underwent a second
restaging biopsy and 1 a third restaging biopsy), 4 patients were awaiting biopsy,
and 2 were lost to follow-up before the first restaging biopsy. At the first restaging
biopsy, of the 76 men, 41 (54%) had no PCa, 16 (21%) continued to have very-low-risk
PCa, 15 (20%) had progressed to low-risk PCa (>2 cores positive and Gleason score ≤6),
and 4 (5%) had progressed to intermediate-risk PCa (Gleason score 7). Of the 76 biopsies,
20 were performed early for cause, with 11 (55%) showing PCa progression. Of the 82
patients, 22 (27%) underwent treatment of PCa.
Conclusion
Active surveillance of very-low-risk PCa in the setting of 5-ARI therapy for benign
prostatic hyperplasia appears to be a safe therapeutic option, because most (57 of
82; 70%) patients maintained very-low-risk PCa or had negative follow-up biopsies
during a 3-year follow-up period. Complementary to the Prostate Cancer Prevention
Trial, our results indicate that 5-ARI therapy increases prostate-specific antigen
sensitivity and can aid the clinician in appropriately targeting biopsies.
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References
- Overview of pivotal studies for prostate cancer risk reduction, past and present.Urol. 2009; 73: 36-43
- Cancer statistics, 2011.CA Cancer J Clin. 2011; 61: 212-236
National Comprehensive Cancer Network. NCCN Prostate Cancer Guidelines. 2011.
- Benign prostatic hyperplasia.Lancet. 2003; 361: 1359-1367
- Effect of dutasteride on the detection of prostate cancer in men with benign prostatic hyperplasia.J Urol. 2004; 64: 537-543
- Due to the effect of finasteride on prostate volume: a modeling approach for analysis of the prostate cancer prevention trial.J Natl Cancer Inst. 2007; 99: 1366-1374
- Prediction of prostate cancer for patients receiving finasteride: results from the Prostate Cancer Prevention Trial.J Clin Oncol. 2007; 25: 3076-3081
- Assessing benefit and risk in the prevention of prostate cancer: the Prostate Cancer Prevention Trial revisited.J Clin Oncol. 2005; 23: 7460-7466
- Dutasteride improves outcomes of benign prostatic hyperplasia when evaluated for prostate cancer risk reduction: secondary analysis of the Reduction by Dutasteride of Prostate Cancer Events trial.J Urol. 2011; 78: 641-647
- Impact of 5-alpha reductase inhibitors on men followed by active surveillance for prostate cancer.Eur Urol. 2011; 59: 509-514
- Dutasteride in localized prostate cancer management: the REDEEM randomized, double-blind, placebo-controlled trial.Lancet. 2012; 379: 1103-1111
- Effect of dutasteride on the sensitivity of PSA for detecting prostate cancer.J Natl Cancer Inst. 2006; 98: 1128-1133
- Permanent interstitial brachytherapy for the management of carcinoma of the prostate gland.J Urol. 2003; 169: 1643-1652
- Impact of prostate gland volume on cryoablation prostate-specific antigen outcomes.Urology. 2011; 77: 994-998
- Brachytherapy for prostate cancer: is the pretreatment prostate volume important?.BJU Int. 2008; 102: 1586-1588
- Quality of life and satisfaction with outcome among prostate-cancer survivors.N Engl J Med. 2008; 358: 1250-1261
- Androgen deprivation for prostate cancer: the case for “first, do no harm.”.Cancer. 2012; 118: 3232-3235
Article info
Publication history
Published online: March 21, 2013
Accepted:
October 26,
2012
Received:
September 24,
2012
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial CommentUrologyVol. 81Issue 5
- PreviewThe use of 5-ARIs in men undergoing active surveillance for low-risk PCa has been controversial. This study adds data that 5-ARI therapy could be beneficial. The results are consistent with those from the REDEEM trial in that a significant majority (75%) of men receiving 5-ARI had no evidence of pathologic cancer progression at the restaging biopsy after a median follow-up of 35 months.
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