1638 EFFECTS OF 5-ALPHA REDUCTASE INHIBITOR USE IN MONITORED MEN WITH VERY-LOW RISK PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized1 Apr 20111638 EFFECTS OF 5-ALPHA REDUCTASE INHIBITOR USE IN MONITORED MEN WITH VERY-LOW RISK PROSTATE CANCER Ashley E. Ross, Feng Zhaoyong, Phillip M. Pierorazio, Patricia Landis, Patrick C. Walsh, H. Ballentine Carter, Bruce J. Trock, and Edward M. Schaeffer Ashley E. RossAshley E. Ross Baltimore, MD More articles by this author , Feng ZhaoyongFeng Zhaoyong Baltimore, MD More articles by this author , Phillip M. PierorazioPhillip M. Pierorazio Baltimore, MD More articles by this author , Patricia LandisPatricia Landis Baltimore, MD More articles by this author , Patrick C. WalshPatrick C. Walsh Baltimore, MD More articles by this author , H. Ballentine CarterH. Ballentine Carter Baltimore, MD More articles by this author , Bruce J. TrockBruce J. Trock Baltimore, MD More articles by this author , and Edward M. SchaefferEdward M. Schaeffer Baltimore, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1747AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Trials using 5-alpha reductase inhibitors (5-ARIs) in populations monitored for the development of prostate cancer suggest that these drugs may suppress the growth of low-risk prostate cancer. In this study we examine whether 5-ARI treatment delays cancer progression in a carefully followed active surveillance cohort. METHODS We evaluated 587 men enrolled in our institutional prostate cancer active surveillance (AS) program that met all entry criteria and had no history of 5-ARI use prior to diagnosis. Data regarding 5-ARI use was collected prospectively. Follow-up consisted of twice-yearly DRE and PSAs and yearly biopsy. Unfavorable surveillance biopsy results included those indicating progression by grade (Gleason score ≥ 7) or volume (> 2 positive cores, or > 50% core involvement). Features of men using 5-ARIs during surveillance were compared to non-users using chi-squared and t-tests. Univariate and multivariable proportional hazard models treating 5-ARI use as a time dependent co-variate were used to evaluate the influence of 5-ARIs on subsequent unfavorable surveillance biopsy. RESULTS 5-ARI use was initiated in 47 men while on surveillance, with a median time from diagnosis to initiation of 1.2 years (range 0–10) and a median period of 5-ARI use of 1.8 years (0.1–9.3). Men using 5-ARIs had, on average, larger prostates and higher PSAs at diagnosis compared to non-users (71 vs 53 ccs and 5.7 vs 4.7 ng/ml respectively, p<0.001 for both). During 5-ARI use, PSA decreased by 47% (−2 to 81%) and prostate volume decreased by 11% (−62 to 57%). Men using 5-ARIs had on average 2.6 surveillance biopsies during drug use and 5 biopsies overall, compared to 3.7 biopsies among non-users. Unfavorable surveillance biopsies occurred in 17% of 5-ARI users compared to 31% of non-users. Multivariable models (adjusting for age, alpha blocker use, PSA, %free PSA, PSA density, prostate volume and number/percent biopsy core involvement at diagnosis) demonstrated statistically non-significant risk reductions for the occurrence of an unfavorable surveillance biopsy in 5-ARI users as determined by either volume (hazard ratio (HR) of 0.37 (95% CI=0.12 to 1.13), p=0.08) or grade criteria (HR of 0.80 (95% CI=0.25–2.59), p=0.7). CONCLUSIONS In our cohort of carefully monitored men with very low-risk prostate cancer, treatment with 5-ARIs for a median time of 2 years did not significantly delay progression of disease as assessed by yearly biopsies. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e657-e658 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ashley E. Ross Baltimore, MD More articles by this author Feng Zhaoyong Baltimore, MD More articles by this author Phillip M. Pierorazio Baltimore, MD More articles by this author Patricia Landis Baltimore, MD More articles by this author Patrick C. Walsh Baltimore, MD More articles by this author H. Ballentine Carter Baltimore, MD More articles by this author Bruce J. Trock Baltimore, MD More articles by this author Edward M. Schaeffer Baltimore, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...