PSA response to finasteride challenge in men with a serum PSA greater than 4 ng/ml and previous negative prostate biopsy: preliminary study - 31/08/11
Abstract |
Objectives. To determine, in a prospective study, the prostate-specific antigen (PSA) response to finasteride challenge in men with a serum PSA greater than 4 ng/mL who had undergone previous biopsy. Patients with a serum PSA level greater than 4 ng/mL who have undergone repeated prostate biopsy with prostate cancer (CaP) that was not detected present a diagnostic dilemma. The magnitude of PSA reduction after administration of finasteride has been well documented. In addition, doubling of the PSA value after 1 year of finasteride has been touted to be a more useful paradigm for diagnosing CaP than PSA alone.
Methods. Thirty-eight men with a baseline serum PSA level greater than 4 ng/mL and a normal digital rectal examination who had been previously biopsied a minimum of two times, with CaP not detected, were given 5 mg finasteride daily. The PSA level was measured at 6 and 12 months with repeat transrectal ultrasonography and biopsy (12 cores) performed at 1 year. Changes in prostate volume, serum PSA, PSA density, and the incidence of CaP at 1 year were assessed.
Results. The mean age of the group was 60.5 years (±7.6). For the group, the average number of previous biopsies performed was 2.9 (range 2 to 6). The baseline PSA level for the entire group was 6.32 ng/mL (±3.2), and the baseline prostate volume was 37.3 cm3 (±12.4). At 1 year, the PSA level had decreased to 3.73 ng/mL (−41.0%), and the prostate volume had decreased to 30.4 cm3 (−18.5%). In the 11 men (29%) in whom CaP was detected, the serum PSA decreased from 7.3 to 5.2 ng/mL (−28.8%) and the prostate volume decreased from 37.3 to 32.3 cm3 (−13.4%). CaP was detected in 0 of 10 men with a serum PSA decrease of 50% or higher, in 6 (32%) of 19 men with a PSA decrease between 33% and 50%, and in 5 (56%) of 9 men who had a PSA decrease of less than 33%.
Conclusions. The data in this preliminary study suggest that the magnitude of change in serum PSA after 1 year of finasteride challenge may be useful in diagnosing CaP in patients with elevated PSA levels and prior negative prostate biopsy.
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Vol 60 - N° 3
P. 464-468 - septembre 2002 Retour au numéro
Article précédent
- Evolution of the presentation and pathologic and biochemical outcomes after radical prostatectomy for patients with clinically localized prostate cancer diagnosed during the PSA era
- Jean O Ung, Jerome P Richie, Ming-Hui Chen, Andrew A Renshaw, Anthony V D’Amico
- Prostate-specific antigen cutoff of 2.6 ng/mL for prostate cancer screening is associated with favorable pathologic tumor features
- Jason S Krumholtz, Gustavo F Carvalhal, Christian G Ramos, Deborah S Smith, Phataraporn Thorson, Yan Yan, Peter A Humphrey, Kimberly A Roehl, William J Catalona
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