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Prostate‐specific antigen density during dutasteride treatment for 1 year predicts the presence of prostate cancer in benign prostatic hyperplasia after the first negative biopsy (PREDICT study)
Author(s) -
Inoue Takaaki,
Yoshimura Koji,
Terada Naoki,
Tsukino Hiromasa,
Murota Takashi,
Kinoshita Hidefumi,
Kamoto Toshiyuki,
Ogawa Osamu,
Matsuda Tadashi
Publication year - 2021
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.14590
Subject(s) - medicine , prostate cancer , dutasteride , prostate , urology , prostate specific antigen , prostate biopsy , biopsy , hyperplasia , pca3 , cancer , oncology
Objectives To prospectively evaluate the detection rate of prostate cancer, and to identify the risk factors of prostate cancer detection after a 1‐year administration of dutasteride and first negative prostate biopsy. Methods Patients with benign prostatic hyperplasia who presented high prostate‐specific antigen levels after the first negative prostate biopsy were administered 0.5 mg dutasteride daily for 1 year. They underwent a repeat prostate biopsy after 1 year. The primary end‐point was the detection rate of prostate cancer. The secondary end‐point was the ability of prostate‐specific antigen kinetics to predict prostate cancer detection. Prostate‐specific antigen was measured before the initial prostate biopsy and at 6, 9 and 12 months after starting dutasteride. Patients were classified into a prostate cancer and a non‐prostate cancer group. Results Prostate cancer was detected in 15 of 149 participants (10.1%). The total prostate‐specific antigen change between the prostate cancer and non‐prostate cancer group at 1 year was significantly different ( P = 0.002). Although prostate‐specific antigen levels at baseline did not significantly differ between study groups ( P = 0.102), prostate‐specific antigen levels at 6, 9 and 12 months were significantly different ( P = 0.002, P = 0.001 and P < 0.001, respectively). The mean reduction rate of prostate‐specific antigen density between the prostate cancer and non‐prostate cancer group at 1 year was significantly different (−4.25 ± 76.5% vs −38.0 ± 28.7%, P = 0.001). Using a multivariate analysis, a >10% increase of prostate‐specific antigen density at 1 year post‐dutasteride treatment was the only predictive risk factor for prostate cancer after the first negative prostate biopsy (odds ratio 11.238, 95% confidence interval 3.112–40.577, P < 0.001). Conclusion In the present study cohort, >10% increase in prostate‐specific antigen density represented the only significant predictive risk factor for prostate cancer diagnosis in patients with elevated prostate‐specific antigen after the first negative prostate biopsy.