Yonsei Med J.  2018 Mar;59(2):219-225. 10.3349/ymj.2018.59.2.219.

Prostate-Specific Antigen Kinetics Following 5α-Reductase Inhibitor Treatment May Be a Useful Indicator for Repeat Prostate Biopsy

• Heo JE
• Koo KC
• Hong SJ
• Park SU
• Chung BH
• Lee KS

• KMID: 2418784
• DOI: http://doi.org/10.3349/ymj.2018.59.2.219

Abstract

PURPOSE
To evaluate parameters for determining repeat prostate biopsy in patients with 5α-reductase inhibitor (5ARI) treatment after initial negative biopsy.
MATERIALS AND METHODS
From January 2007 to December 2015, patients who underwent a repeat prostate biopsy after an initial negative biopsy were enrolled from multiple institutions. Serial prostate-specific antigen (PSA) levels after the initial biopsy were analyzed for PSA kinetics. Clinicopathologic variables were evaluated according to the use of 5ARIs after the initial negative biopsy.
RESULTS
Of 419 patients with initial negative biopsies (median age=67.0 years, median PSA=6.31 ng/mL), 101 patients (24.1%) were diagnosed with prostate cancer at the repeat biopsy. An increase in PSA level at 18 months, compared to that at 6 months, was a predictor of a positive repeat biopsy. However, the use of 5ARIs was not identified as a predictor. Of 126 patients receiving 5ARI treatment after the initial biopsy, 30 (23.8%) were diagnosed with prostate cancer at the repeat biopsy. Increase in PSA level at more than two time points after 6 months of 5ARI treatment (odds ratio=4.84, p=0.005) was associated with cancer detection at the repeat biopsy. There were no significant 5ARI group-related differences in the detection rates of prostate and high-grade cancers (Gleason score ≥7).
CONCLUSION
The effects of 5ARIs on prostate cancer detection and chemoprevention remain uncertain. However, more than two increases in PSA level after 6 months of 5ARI treatment may indicate the presence of prostate cancer.

Keyword

Prostate biopsy; prostate-specific antigen; 5α-reductase inhibitors

MeSH Terms

5-alpha Reductase Inhibitors/*therapeutic use
Aged
*Biopsy
Follow-Up Studies
Humans
Kinetics
Male
Middle Aged
Neoplasm Grading
Predictive Value of Tests
Prostate-Specific Antigen/*blood
Prostatic Neoplasms/blood/*drug therapy/*pathology
5-alpha Reductase Inhibitors
Prostate-Specific Antigen

Figure

• 

  Fig. 1 Algorithm to recommend repeat prostate biopsy in patients undergoing 5ARI treatment. 5ARIs, 5α-reductase inhibitors; PSA, prostate-specific antigen.

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