The effects of 5α-reductase inhibitors on the natural history, detection and grading of prostate cancer

Current state of knowledge

Gerald Andriole, David Bostwick, Francisco Civantos, Jonathan Epstein, M. Scott Lucia, John McConnell, Claus G. Roehrborn

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Purpose: The Prostate Cancer Prevention Trial (PCPT) showed that the 5α-reductase inhibitor (5ARI) finasteride significantly decreased the 7-year period prevalence of prostate cancer vs placebo. However, Gleason score 7-10 tumors were significantly more common in the finasteride vs the placebo group. We considered data on the effects of 5ARIs on prostate cancer natural history and detection. Materials and Methods: A detailed review was performed of the literature identified from the MEDLINE database examining the effects of 5ARIs on prostate cancer prevalence and tumor histopathology. Results: In PCPT there were fewer biopsies performed for cause in the finasteride vs the placebo group and the proportion of high grade tumors in the treatment groups did not diverge with time. Given that finasteride has an effect on prostate specific antigen and prostate volume, which are key factors in triggering prostate biopsies, they may be significant confounders of Gleason score results. Prostate shrinkage in the finasteride treated group may minimize biopsy sampling error. Furthermore, histological studies have shown that 5ARIs have a significant effect on prostate architecture, which can make the interpretation of prostate specimens in men treated with 5ARIs difficult. Further evaluation of PCPT findings will help determine the true nature of these observations. Conclusions: 5ARIs decrease the risk of prostate cancer but also alter the detection of disease through effects on prostate specific antigen, and prostate volume and histology. The weight of evidence suggests an artifactual effect of finasteride on Gleason grading in the PCPT. The role of 5ARIs for prostate cancer chemoprevention needs further examination before it can be considered for wide recommendation.

Original languageEnglish
Pages (from-to)2098-2104
Number of pages7
JournalJournal of Urology
Volume174
Issue number6
DOIs
StatePublished - Dec 1 2005

Fingerprint

Natural History
Finasteride
Prostatic Neoplasms
Oxidoreductases
Prostate
Neoplasm Grading
Placebos
Prostate-Specific Antigen
Biopsy
Neoplasms
Selection Bias
Chemoprevention
MEDLINE
Histology
Databases
Weights and Measures

Keywords

  • Chemoprevention
  • Cholestenone 5 alpha-reductase
  • Prostate
  • Prostatic neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

The effects of 5α-reductase inhibitors on the natural history, detection and grading of prostate cancer : Current state of knowledge. / Andriole, Gerald; Bostwick, David; Civantos, Francisco; Epstein, Jonathan; Lucia, M. Scott; McConnell, John; Roehrborn, Claus G.

In: Journal of Urology, Vol. 174, No. 6, 01.12.2005, p. 2098-2104.

Research output: Contribution to journalArticle

Andriole, Gerald ; Bostwick, David ; Civantos, Francisco ; Epstein, Jonathan ; Lucia, M. Scott ; McConnell, John ; Roehrborn, Claus G. / The effects of 5α-reductase inhibitors on the natural history, detection and grading of prostate cancer : Current state of knowledge. In: Journal of Urology. 2005 ; Vol. 174, No. 6. pp. 2098-2104.
@article{9f945035dfae4583b1541f19fa357180,
title = "The effects of 5α-reductase inhibitors on the natural history, detection and grading of prostate cancer: Current state of knowledge",
abstract = "Purpose: The Prostate Cancer Prevention Trial (PCPT) showed that the 5α-reductase inhibitor (5ARI) finasteride significantly decreased the 7-year period prevalence of prostate cancer vs placebo. However, Gleason score 7-10 tumors were significantly more common in the finasteride vs the placebo group. We considered data on the effects of 5ARIs on prostate cancer natural history and detection. Materials and Methods: A detailed review was performed of the literature identified from the MEDLINE database examining the effects of 5ARIs on prostate cancer prevalence and tumor histopathology. Results: In PCPT there were fewer biopsies performed for cause in the finasteride vs the placebo group and the proportion of high grade tumors in the treatment groups did not diverge with time. Given that finasteride has an effect on prostate specific antigen and prostate volume, which are key factors in triggering prostate biopsies, they may be significant confounders of Gleason score results. Prostate shrinkage in the finasteride treated group may minimize biopsy sampling error. Furthermore, histological studies have shown that 5ARIs have a significant effect on prostate architecture, which can make the interpretation of prostate specimens in men treated with 5ARIs difficult. Further evaluation of PCPT findings will help determine the true nature of these observations. Conclusions: 5ARIs decrease the risk of prostate cancer but also alter the detection of disease through effects on prostate specific antigen, and prostate volume and histology. The weight of evidence suggests an artifactual effect of finasteride on Gleason grading in the PCPT. The role of 5ARIs for prostate cancer chemoprevention needs further examination before it can be considered for wide recommendation.",
keywords = "Chemoprevention, Cholestenone 5 alpha-reductase, Prostate, Prostatic neoplasms",
author = "Gerald Andriole and David Bostwick and Francisco Civantos and Jonathan Epstein and Lucia, {M. Scott} and John McConnell and Roehrborn, {Claus G.}",
year = "2005",
month = "12",
day = "1",
doi = "10.1097/01.ju.0000181216.71605.38",
language = "English",
volume = "174",
pages = "2098--2104",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - The effects of 5α-reductase inhibitors on the natural history, detection and grading of prostate cancer

T2 - Current state of knowledge

AU - Andriole, Gerald

AU - Bostwick, David

AU - Civantos, Francisco

AU - Epstein, Jonathan

AU - Lucia, M. Scott

AU - McConnell, John

AU - Roehrborn, Claus G.

PY - 2005/12/1

Y1 - 2005/12/1

N2 - Purpose: The Prostate Cancer Prevention Trial (PCPT) showed that the 5α-reductase inhibitor (5ARI) finasteride significantly decreased the 7-year period prevalence of prostate cancer vs placebo. However, Gleason score 7-10 tumors were significantly more common in the finasteride vs the placebo group. We considered data on the effects of 5ARIs on prostate cancer natural history and detection. Materials and Methods: A detailed review was performed of the literature identified from the MEDLINE database examining the effects of 5ARIs on prostate cancer prevalence and tumor histopathology. Results: In PCPT there were fewer biopsies performed for cause in the finasteride vs the placebo group and the proportion of high grade tumors in the treatment groups did not diverge with time. Given that finasteride has an effect on prostate specific antigen and prostate volume, which are key factors in triggering prostate biopsies, they may be significant confounders of Gleason score results. Prostate shrinkage in the finasteride treated group may minimize biopsy sampling error. Furthermore, histological studies have shown that 5ARIs have a significant effect on prostate architecture, which can make the interpretation of prostate specimens in men treated with 5ARIs difficult. Further evaluation of PCPT findings will help determine the true nature of these observations. Conclusions: 5ARIs decrease the risk of prostate cancer but also alter the detection of disease through effects on prostate specific antigen, and prostate volume and histology. The weight of evidence suggests an artifactual effect of finasteride on Gleason grading in the PCPT. The role of 5ARIs for prostate cancer chemoprevention needs further examination before it can be considered for wide recommendation.

AB - Purpose: The Prostate Cancer Prevention Trial (PCPT) showed that the 5α-reductase inhibitor (5ARI) finasteride significantly decreased the 7-year period prevalence of prostate cancer vs placebo. However, Gleason score 7-10 tumors were significantly more common in the finasteride vs the placebo group. We considered data on the effects of 5ARIs on prostate cancer natural history and detection. Materials and Methods: A detailed review was performed of the literature identified from the MEDLINE database examining the effects of 5ARIs on prostate cancer prevalence and tumor histopathology. Results: In PCPT there were fewer biopsies performed for cause in the finasteride vs the placebo group and the proportion of high grade tumors in the treatment groups did not diverge with time. Given that finasteride has an effect on prostate specific antigen and prostate volume, which are key factors in triggering prostate biopsies, they may be significant confounders of Gleason score results. Prostate shrinkage in the finasteride treated group may minimize biopsy sampling error. Furthermore, histological studies have shown that 5ARIs have a significant effect on prostate architecture, which can make the interpretation of prostate specimens in men treated with 5ARIs difficult. Further evaluation of PCPT findings will help determine the true nature of these observations. Conclusions: 5ARIs decrease the risk of prostate cancer but also alter the detection of disease through effects on prostate specific antigen, and prostate volume and histology. The weight of evidence suggests an artifactual effect of finasteride on Gleason grading in the PCPT. The role of 5ARIs for prostate cancer chemoprevention needs further examination before it can be considered for wide recommendation.

KW - Chemoprevention

KW - Cholestenone 5 alpha-reductase

KW - Prostate

KW - Prostatic neoplasms

UR - http://www.scopus.com/inward/record.url?scp=27744492261&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=27744492261&partnerID=8YFLogxK

U2 - 10.1097/01.ju.0000181216.71605.38

DO - 10.1097/01.ju.0000181216.71605.38

M3 - Article

VL - 174

SP - 2098

EP - 2104

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 6

ER -