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Gleason grade remains an important prognostic predictor in men diagnosed with prostate cancer while on finasteride therapy
Author(s) -
Carver Brett S.,
Kattan Michael W.,
Scardino Peter T.,
Eastham James A.
Publication year - 2005
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/j.1464-410x.2005.05375.x
Subject(s) - medicine , finasteride , prostate cancer , nomogram , urology , prostatectomy , biopsy , pathological , prostate specific antigen , prostate , prostate biopsy , cancer , surgery
The controversial topic of the effect of finasteride therapy on Gleason grade, raised by the Prostate Cancer Prevention Trial, is discussed by authors from New York. They assessed a series of patients who had been treated with finasteride, and who subsequently had a radical prostatectomy, to see if this pharmaceutical agent prevented accurate Gleason grade assignment and prediction of biochemical recurrence. They found that Gleason grade remains an important prognostic predictor in men diagnosed with prostate cancer while on finasteride therapy. Authors from Amsterdam assessed the accuracy of ultrasonography‐guided fine‐needle aspiration cytology as a method of detecting occult lymph node metastases in patients with penile cancer, and found that it can be used as an initial investigation in such patients, with helpful clinical outcomes. OBJECTIVE To evaluate men treated with finasteride for lower urinary tract symptoms, who subsequently were diagnosed with prostate cancer and had a radical prostatectomy (RP) at our institution, to determine if finasteride therapy prevented accurate Gleason grade assignment and prediction of biochemical recurrence. PATIENTS AND METHODS Between May 1996 and July 2003, 45 men were identified who had RP and had previously been treated with finasteride for ≥ 6 months before the diagnosis of prostate cancer. Clinical and pathological information was gathered from a RP database. Serum prostate‐specific antigen (PSA) level, duration of finasteride therapy, biopsy Gleason grade, clinical stage, RP Gleason grade and pathological stage were reviewed. Freedom from recurrence was predicted using validated nomograms before and after RP, and compared against actuarial 5‐year freedom from recurrence using the Kaplan‐Meier method. RESULTS The mean duration of finasteride therapy before diagnosis was 23.6 months, the mean serum PSA (doubled to account for finasteride use) 11.02 ng/mL and mean biopsy Gleason score 6. When comparing the biopsy and RP specimen Gleason score, it was downgraded by 1 point in six men, upgraded by 1 point in eight, and upgraded by 2 points in one. The Gleason score was constant in 30 patients. The nomograms predicted freedom from recurrence in 83% and 85%, respectively; the 5‐year actuarial freedom from recurrence was 86%. CONCLUSION Finasteride does not appear to compromise the assignment of Gleason grade for use in prediction tools before or after RP in men undergoing prostate biopsy or RP. The actuarial 5‐year freedom from recurrence was similar to that predicted by the validated nomograms. Gleason grade remains an important prognostic predictor in men treated with finasteride and undergoing RP for clinically localized prostate cancer.