Prostate-Specific Antigen Kinetics Following 5α-Reductase Inhibitor Treatment May Be a Useful Indicator for Repeat Prostate Biopsy

PURPOSE: To evaluate parameters for determining repeat prostate biopsy in patients with 5α-reductase inhibitor (5ARI) treatment after initial negative biopsy. MATERIALS AND METHODS: From January 2007 to December 2015, patients who underwent a repeat prostate biopsy after an initial negative biopsy were enrolled from multiple institutions. Serial prostate-specific antigen (PSA) levels after the initial biopsy were analyzed for PSA kinetics. Clinicopathologic variables were evaluated according to the use of 5ARIs after the initial negative biopsy. RESULTS: Of 419 patients with initial negative biopsies (median age=67.0 years, median PSA=6.31 ng/mL), 101 patients (24.1%) were diagnosed with prostate cancer at the repeat biopsy. An increase in PSA level at 18 months, compared to that at 6 months, was a predictor of a positive repeat biopsy. However, the use of 5ARIs was not identified as a predictor. Of 126 patients receiving 5ARI treatment after the initial biopsy, 30 (23.8%) were diagnosed with prostate cancer at the repeat biopsy. Increase in PSA level at more than two time points after 6 months of 5ARI treatment (odds ratio=4.84, p=0.005) was associated with cancer detection at the repeat biopsy. There were no significant 5ARI group-related differences in the detection rates of prostate and high-grade cancers (Gleason score ≥7). CONCLUSION: The effects of 5ARIs on prostate cancer detection and chemoprevention remain uncertain. However, more than two increases in PSA level after 6 months of 5ARI treatment may indicate the presence of prostate cancer.

Effect of dutasteride to benign prostatic hyperplasia with large volume in the medium-short term / 中华泌尿外科杂志

Objective To verify the short and medium term effect of dutasteride in the treatment of lower urinary tract symptoms ( LUTS) secondary to benign prostatic hyperplasia( BPH) with prostate volume≥40 ml.Methods One hundred and seven patients diagnosed as BPH accompanying moderate-to-severe LUTS who met the inclusion/exclusion criteria were enrolled from July 2013 to September 2014.After 12 weeks of treatment with dutasteride 0.5 mg/d, the primary outcome was international prostate symptom score (IPSS) change from baseline at Week 12, and the secondary outcome was Quality of Life (QOL) score before and after the treatment, maximun flow rate ( Qmax ) , and the change in residual urine volume. Comparing with baseline, patients with the rate of IPSS decline ≥30% ( effective group) continued taking dutasteride for another 4 weeks then undergoing the prostate volume and PSA measurement.In addition, patients with the rate of IPSS decline <30% were administered combination therapy with dutasteride and tamsulosin (0.2mg/d), their IPSS at Week 16 were compared with that at Week 12, and their prostate volume and PSA level were followed up until Week 20.The prostate volume and PSA changing were followed up.Results Compared with baseline, after 12 weeks of treatment with dutasteride, patients'IPSS decreased 5.54 points ( P <0.01 ) , including 59 patients ( 55.14%) with IPSS decline rate ≥30%, QOL score decreased 1.56 points (P<0.01), Qmax increased 1.07 ml /s (P=0.049), and residual urine decreased 6.46 ml (P=0.107).IPSS declined ≥30% in 42 patients at Week 12, whose prostate volume reduced 14.15%at Week 16 follow-up, with PSA declining of 0.68 ng /ml in 32 tested cases ( P=0.008).IPSS declining <30%in 36 patients at Week 12 was followed up to Week 20, and their prostate volume reduced 11.89%, with PSA declining of 0.18 ng/ml ( P=0.589) in 33 tested patients.Conclusions Dutasteride can improve the lower urinary tract symptom in patients who are diagnosed as BPH accompanying moderate-to-severe LUTS with prostate volume ≥ 40 ml significantly.Tamsulosin add-on treatment benefited most patients.