Prognostic influence of 5 alpha reductase inhibitors in patients with localized prostate cancer under active surveillance

Abstract

Cite this article as: Özkan TA, Cebeci OÖ, Çevik İ, Dillioğlugil Ö. Prognostic influence of 5 alpha reductase inhibitors in patients with localized prostate cancer under active surveillance. Turk J Urol 2018; 44(2): 132-7. ABSTRACTObjective: The incidence of prostate adenocarcinoma (PCa) is increased with the use of prostate-specific antigen (PSA). In the current study, we aimed to investigate the impact of 5-alpha-reductase inhibitors (5-ARI) on pathological progression in patients followed by active surveillance (AS). Material and methods:Records of 69 patients with localized prostate cancer under AS (PSA ≤15 ng/mL, PSAD ≤0.20, ≤cT2c, Gleason sum ≤3+3, the number of cancer positive cores ≤3) were evaluated retrospectively. Patients were followed-up with quarterly PSA testing and semiannual digital rectal examination during the first 2 years, and semiannual PSA testing thereafter. Repeat biopsies were done annually and whenever indicated by clinical findings. Pathological progression was defined as increasing Gleason grade, number of cancer-positive cores, and/or increasing percentage of cancer in any core. Results:Patients using (29/69: 42%) and not using (40/69: 58%) 5-ARI were followed for a median of 39 (IQR: 23-45) and 23.5 (IQR: 17-37.5) months, respectively. Pathological progression was observed in 32% (22/69) of the patients at a median of 25 (IQR: 18-39) months. Pathological progression was observed in 34.5% (10/29) and 30% (12/40) of the patients using and not using 5-ARI, respectively (Log-rank p= 0.4151). Definitive treatment was done in 31% (9/29) and 47.5% (19/40) of the patients using and not using 5-ARI, respectively. Patients who did not use 5-ARI received definitive treatment earlier than 5-ARI users (Logrank p= 0.0342). On multivariate analysis, more than 2 cancer-positive cores (HR: 11.62) and age (HR: 0.94) were independently associated with pathological progression (p<0.05), rather than 5-ARI use (p= 0.148). Conclusion:More than 2 cancer-positive cores at the initial biopsy was the strongest covariate associated with pathological progression; these patients should not be offered AS. There was no impact of 5-ARI use on pathological progression in AS.

Prostate cancer patients can benefit from 5-alpha-reductase inhibitor treatment: a meta-analysis

“…Ten studies (Andriole et al, 1995;Banez et al, 2009;Chu et al, 2015;Dai et al, 2018;Dutkiewicz, 2012;Finelli et al, 2011;Fleshner et al, 2012;Ozkan et al, 2018;Ross et al, 2012;Schroder et al, 2013) containing 2,277 PCa patients were involved in this analysis (Fig. 1).…”

“…All literature was published between 1995 to 2018. Among them, five were RCTs (Andriole et al, 1995;Chu et al, 2015;Dutkiewicz, 2012;Fleshner et al, 2012;Schroder et al, 2013), one was prospective cohort study (Banez et al, 2009), and other four were retrospective cohort studies (Dai et al, 2018;Finelli et al, 2011;Ozkan et al, 2018;Ross et al, 2012). Most studies focused on local PCa, while metastatic PCa (Dutkiewicz, 2012) and non-metastatic CRPC (Chu et al, 2015) were investigated in only one study respectively.…”

“…In low-risk PCa, 5ARIs led to lower rates of pathologic progression and aggressive treatments in patients receiving AS (Finelli et al, 2011;Fleshner et al, 2012). Contradictorily, recent studies demonstrated that 5ARIs did not benefit the grade reclassification and pathologic progression for PCa patients on AS (Dai et al, 2018;Ozkan et al, 2018). Adding dutasteride to bicalutamide also could not delay the disease progression in patients with non-metastatic castration-resistant prostate cancer (CRPC) (Chu et al, 2015).…”