Open AccessUtility of 5-alpha-reductase inhibitors in active surveillance for favourable risk prostate cancer
Author(s) -
Audris Chiang,
D.A. Loblaw,
Vibhuti Jethava,
Perakaa Sethukavalan,
Liying Zhang,
Danny Vesprini,
Alexandre Mamedov,
Robert K. Nam,
Laurence Klotz
Publication year - 2013
Publication title -
canadian urological association journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.477
H-Index - 38
eISSN - 1920-1214
pISSN - 1911-6470
DOI - 10.5489/cuaj.262
Subject(s) - nadir , prostate cancer , medicine , prostate , cohort , urology , retrospective cohort study , cancer , prostate specific antigen , surgery , oncology , satellite , engineering , aerospace engineering
This retrospective review compares prostate-specific antigen (PSA) doubling time (DT) prior to the initiation of a 5-alpha reductase inhibitor (pre-5-ARI) to after the PSA nadir (post-nadir) has been reached for patients on active surveillance for favourable risk prostate cancer.Methods: Between 1996 and 2010, a total of 100 men with a history of 5-ARI use were captured from our active surveillancedatabase. Twenty-nine patients had a sufficient number of PSA values to determine both pre-5-ARI and post-nadir DTs. PSADT was calculated using the general linear mixed-model method.Results: The median follow-up was 69.5 months. The median pre-5-ARI PSADT was 55.8 (range: 6-556.8) months, while the post-nadir value was 25.2 (range: 6-231) months (p = 0.0081). Six patients were reclassified after an average of 67.7 (range: 59-95) months, due to progression in PSADT (n = 2) or Gleason score (n = 4). The median pre-5-ARI and post-nadir DTs for this group were 42.3 (range: 32.4-91.1) and 21.1 (range: 6-44.3) months, respectively.Conclusion: 5-ARIs significantly decreased PSADT compared to prior to their initiation. This effect may be due to preferential suppression of benign tissue following PSA nadir. The resulting PSADT would then represent a more accurate depiction of the true cancer related DT. If validated with a larger cohort, 5-ARIs may enhance the utility of PSADT as a biomarker of disease progression in active surveillance.