No AccessJournal of UrologyAdult Urology1 Sep 2012

Prostate Biopsy in Response to a Change in Nadir Prostate Specific Antigen of 0.4 ng/ml after Treatment with 5α-Reductase Inhibitors Markedly Enhances the Detection Rate of Prostate Cancer

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    We examined the effect of 5α-reductase inhibitor therapy on prostate cancer detection in men with persistently increased or fluctuating prostate specific antigen and prior negative prostate cancer biopsy.

    Materials and Methods:

    A total of 276 men with prostate specific antigen greater than 4 ng/ml (208) or a prostate specific antigen velocity change of 0.75 ng/ml (68) and a normal digital rectal examination who had previously undergone biopsy a minimum of 2 times with prostate cancer not detected were given 5 mg finasteride (154) or dutasteride (122) daily. In phase 1, 97 patients had prostate specific antigen measured at 6 and 12 months with repeat transrectal ultrasonography and biopsy (12 cores) performed at 1 year. In phase 2, 179 patients underwent biopsy triggered by a change in nadir prostate specific antigen of more than 0.4 ng/ml.


    In phase 1 at 1 year prostate specific antigen had decreased by 2.4 ng/ml (−46.7%), and prostate volume had decreased 7.1 ml (−17.9%). Prostate cancer was detected in 27 of 97 (27.8%) patients and the mean minimum prostate specific antigen velocity from a nadir of 0.4 ng/ml was 0.6 ng/ml. In phase 2, 48 of 179 (26.8%) men underwent repeat biopsy at a mean of 14.6 months. Of these 48 men 26 (54.1%) were found to have prostate cancer. Of the 26 men in whom prostate cancer was detected 20 (76.9%) were found to have Gleason score 7 or greater disease.


    The magnitude of change in serum prostate specific antigen after 5α-reductase inhibitor therapy may be useful in diagnosing prostate cancer in patients with persistently increased or fluctuating prostate specific antigen and prior negative prostate biopsy.


    • 1 : Incidence and clinical significance of false-negative sextant prostate biopsies. J Urol1998; 159: 1247. LinkGoogle Scholar
    • 2 : Systematic 5 region prostate biopsy is superior to sextant method for diagnosing carcinoma of the prostate. J Urol1997; 157: 199. LinkGoogle Scholar
    • 3 : The optimal systematic prostate biopsy scheme should include 8 rather than 6 biopsies: results of a prospective clinical trial. J Urol2000; 163: 163. LinkGoogle Scholar
    • 4 : Extensive repeat transrectal ultrasound guided prostate biopsy in patients with previous benign sextant biopsies. J Urol2000; 163: 158. LinkGoogle Scholar
    • 5 : A comparative analysis of sextant and an extended 11-core multisite directed biopsy strategy. J Urol2000; 163: 152. LinkGoogle Scholar
    • 6 : Two consecutive series of transrectal ultrasound guided sextant biopsies of the prostate for the detection of prostate cancer. J Urol1998; 159: 471. LinkGoogle Scholar
    • 7 : Serial prostatic biopsies in men with persistently elevated serum prostate specific antigen values. J Urol1994; 151: 1571. LinkGoogle Scholar
    • 8 : Prostate cancer distribution in patients diagnosed by transperineal template-guided saturation biopsy. Eur Urol2007; 52: 715. Google Scholar
    • 9 : PSA response to finasteride challenge in men with a serum PSA greater than 4 ng/ml and previous negative prostate biopsy: preliminary study. Urology2002; 60: 464. Google Scholar
    • 10 : Prostate specific antigen as a serum marker for adenocarcinoma of the prostate. N Engl J Med1987; 317: 909. Google Scholar
    • 11 : Effect of finasteride on prostate specific antigen: review of available data. J Urol1996; 155: 3. LinkGoogle Scholar
    • 12 : Effect of finasteride on prostate-specific antigen density. Urology1994; 43: 53. Google Scholar
    • 13 : Prostate tissue composition and response to finasteride in men with symptomatic benign prostatic hyperplasia. J Urol1997; 157: 2171. LinkGoogle Scholar
    • 14 : Levels of 5alpha-reductase type 1 and type 2 are increased in localized high grade compared to low grade prostate cancer. J Urol2008; 179: 147. LinkGoogle Scholar
    • 15 : Long-term effects of finasteride on prostate specific antigen levels: results from the Prostate Cancer Prevention Trial. J Urol2005; 174: 877. LinkGoogle Scholar
    • 16 : Effect of finasteride on the sensitivity of PSA for detecting prostate cancer. J Natl Cancer Inst2006; 98: 1128. Google Scholar
    • 17 : Effect of dutasteride on the risk of prostate cancer. N Engl J Med2010; 362: 1192. Google Scholar
    • 18 : The effect of dutasteride on the usefulness of prostate specific antigen for the diagnosis of high grade and clinically relevant prostate cancer in men with a previous negative biopsy: results from the REDUCE study. J Urol2011; 185: 126. LinkGoogle Scholar
    • 19 : The risks and benefits of 5α-reductase inhibitors for prostate-cancer prevention. N Engl J Med2011; 365: 97. Google Scholar
    • 20 : The influence of finasteride on the development of prostate cancer. N Engl J Med2003; 349: 215. Google Scholar
    • 21 : Dutasteride in localised prostate cancer management: the REDEEM randomised, double-blind, placebo-controlled trial. Lancet2012; 379: 1103. Google Scholar
    • 22 : Prostate cancer and the Will Rogers phenomenon. J Natl Cancer Inst2005; 97: 1248. Google Scholar
    • 23 : Biologic variability of prostate-specific antigen and its usefulness as a marker for prostate cancer: effects of finasteride. Urology1997; 50: 13. Google Scholar
    • 24 : The effect of finasteride on the prostate gland in men with elevated serum prostate-specific antigen levels. Br J Cancer1998; 78: 413. Google Scholar
    • 25 : Treatment with finasteride preserves usefulness of prostate-specific antigen in the detection of prostate cancer: results of a randomized, double-blind, placebo-controlled clinical trial: PLESS Study Group. Proscar Long-term Efficacy and Safety Study. Urology1998; 52: 195. Google Scholar
    • 26 : Effect of dutasteride on prostate biopsy rates and the diagnosis of prostate cancer in men with lower urinary tract symptoms and enlarged prostates in the Combination of Avodart and Tamsulosin trial. Eur Urol2011; 59: 244. Google Scholar

    Weill Cornell Medical College, Cornell University, New York, New York