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Comparison of percent free prostate-specific antigen levels in men with benign prostatic hyperplasia treated with finasteride, terazosin, or watchful waiting

  • David W. Keetch
    Correspondence
    Reprint requests: D.W. Keetch, M.D., Division of Urologic Surgery, 1040 North Mason Road, Suite 122, St. Louis, MO 63141.
    Affiliations
    From the Division of UrologiC Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

    From the Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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  • Gerald L. Andriole
    Affiliations
    From the Division of UrologiC Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

    From the Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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  • Timothy L. Ratliff
    Affiliations
    From the Division of UrologiC Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

    From the Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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  • William J. Catalona
    Affiliations
    From the Division of UrologiC Surgery, Washington University School of Medicine, St. Louis, Missouri, USA

    From the Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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      Abstract

      Objectives

      Finasteride is known to lower total serum prostate-specific antigen (PSA) levels by approximately 50%. Terazosin is thought to have little or no effect on serum PSA concentration. The objective of our study was to determine the effect of finasteride and terazosin on serum total and serum free PSA levels and the ratio of free to total PSA.

      Methods

      We identified 69 men with symptomatic benign prostatic hyperplasia (BPH) who had been receiving 5 mg/day (n = 33) of finasteride or 2 to 5 mg/day (n = 14) of terazosin or no therapy (“watchful waiting”) (n = 22). The three groups were compared with respect to pretreatment total serum PSA levels and post-treatment total, free, and percent free serum PSA levels.

      Results

      Median (± semi-interquartile range [SIR]) pretreatment total serum PSA levels (ng/mL) were not significantly different in men taking finasteride (2.8 ± 1.9), terazosin (2.2 ± 2.5), or undergoing watchful waiting (5.5 ± 1.4) (p = 0.12). The median (± SIR) post-treatment total serum PSA levels (ng/mL) were significantly lower in the finasteride group (1.1 ± 1) when compared with the terazosin (2.5 ± 1.5) or watchful waiting (4.3 ± 2.8) groups (p = 0.016). Only the finasteride group had significantly lower post-treatment total serum PSA levels compared with pretreatment levels. The median (± SIR) post-treatment free PSA levels were significantly lower in the finasteride group (0.26 ± 0.16) compared with the terazosin (0.54 ± 0.5) and watchful waiting (0.85 ± 0.5) groups (p = 0.0015). However, the median (± SIR) percent free PSA was not significantly different in the finasteride (23 ± 6), terazosin (22 ± 4), and watchful waiting (25 ± 5) groups (p = 0.66).

      Conclusions

      Finasteride appears to lower total and free PSA levels equally in men with BPH and does not appear to change the ratio of free to total serum PSA. Terazosin does not appear to alter total or free serum PSA levels in men with BPH. The percent free PSA could potentially be used to screen for prostate cancer in men taking finasteride. Prospective studies are needed to further evaluate this issue.
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