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Active Surveillance of Very-low-risk Prostate Cancer in the Setting of Active Treatment of Benign Prostatic Hyperplasia With 5α-reductase Inhibitors

      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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      • Editorial Comment
        UrologyVol. 81Issue 5
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          The 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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