Active surveillance an option for some low-risk prostate cancer patients
medwireNews: Active surveillance of individuals with very-low-risk prostate cancer (PCa) who are also on 5 α-reductase inhibitor (5-ARI) therapy for benign prostatic hyperplasia (BPH) seems to be a viable therapeutic option, say researchers.
In a study of 82 patients, the majority (70%) either maintained very-low-risk PCa or had negative biopsies over a mean follow-up period of 35 months after initial biopsy diagnosis of PCa, report Michael Rydberg (Carolinas Medical Center, Charlotte, North Carolina, USA) and colleagues.
"Because BPH is commonly seen in conjunction with PCa, it is important to understand the influence of 5-ARI therapy on very-low-risk, low-volume PCa," they explain.
The researchers reviewed medical charts available for 82 patients, aged a mean of 63 years, who had been diagnosed with BPH (prostate volume >30cm3), had a prostate specific antigen (PSA) level over 0.15 ng/mL, and had very-low-risk PCa (as defined by the 2011 National Comprehensive Cancer Network guidelines) on initial prostate biopsy. The patients were prescribed either finasteride or dutasteride and began active surveillance with digital rectal examinations and PSA measurement every 6 months.
All patients completed 1 year of 5-ARI therapy or underwent an early biopsy for cause and 76 men underwent a restaging biopsy.
As reported in Urology, 41 (56%) of those who underwent the restaging biopsy had no detectable PCa, while 16 (21%) continued to have very-low-risk disease risk and 19 (25%) progressed to low- or intermediate-risk PCa. No patients progressed to high-risk PCa, and no PCa with a Gleason score of 8, 9, or 10 was diagnosed.
"Most of our patients remained at very low risk or had no detectable PCa found on the restaging biopsy," write Rydberg and team.
In addition, the mean PSA level decreased significantly from 4.9 ng/mL at the beginning of the study to 2.2 ng/mL after 1 year of 5-ARI therapy.
Furthermore, only 29 (35%) individuals had a prostate volume below 50 cm3 at baseline, while after 1 year of 5-ARI therapy, 46 (61%) of 76 patients had a prostate volume that was below this cutoff, a significant improvement.
"The treatment of patients with BPH, mild to moderate lower urinary tract symptoms, and minimal low-grade PCa is a common clinical dilemma for current urologists," explain the researchers. Recent studies have suggested the potential benefit of 5-ARIs for such patients, but they have also demonstrated a 0.5 to 1.0% increase in high-grade PCa in patients.
However, the authors say the current findings "indicate that 5-ARI therapy increases prostate-specific antigen sensitivity and can aid the clinician in appropriately targeting biopsies."
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By Sally Robertson, medwireNews Reporter