Differences in the rate of lymph node invasion in men with clinically localized prostate cancer might be related to the continent of origin

OBJECTIVE

To test whether the rate of lymph node invasion (LNI) differs between patients treated with radical prostatectomy (RP) at a European or a North American centre.

PATIENTS AND METHODS

In all, 1385 men had RP with bilateral lymphadenectomy for clinically localized prostate cancer (587 from Dallas, Texas and 798 from Milan, Italy). Univariate and multivariate analyses focused on the association between the continent of origin and the rate of LNI, after controlling for prostate-specific antigen (PSA) level, clinical stage, biopsy Gleason sum and the number of examined and removed lymph nodes.

RESULTS

European men had higher PSA levels (9.1 vs 7.8 ng/mL), a higher proportion of palpable cancers (44.5 vs 32.8%), more nodes removed (mean 14.9 vs 7.8) and a higher rate of LNI (9.0% vs 1.2%; all differences P < 0.001). In multivariate analyses that controlled for PSA level and clinical variables, European men had an 8.9-fold higher risk of LNI (P < 0.001) than their counterparts from the USA. Among preoperative variables, the continent of origin was the third most informative predictor of LNI (67.5%), after biopsy Gleason sum (74.3%) and the number of examined lymph nodes (71.0%), and improved the ability to predict LNI by 4.7%.

CONCLUSION

Men treated at a European centre had a 7.3-8.9-fold higher rate of LNI, despite adjusting for all clinical and pathological variables. It remains to be shown what predisposes European men to a higher rate of LNI.

Effects of alfuzosin 10 mg once daily on sexual function in men treated for symptomatic benign prostatic hyperplasia

We evaluated the effects of extended-release alfuzosin HCl 10 mg once daily (q.d.) on sexual function in men with lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). In a randomized, double-blind, placebo-controlled study of men aged > or = 50 years, after a 28-day placebo run-in period, patients were randomized to receive alfuzosin 10 mg q.d. or matching placebo for 28 days. The mean change from baseline (day 1) in sexual function on day 29 was assessed using the Danish Prostate Symptom Score Sex (DAN-PSSsex) questionnaire. A total of 372 patients were randomized to receive alfuzosin (n=186) or placebo (n=186), with 355 completing the study. At baseline, 64% of the patients reported erectile dysfunction (ED) and 63% reported ejaculatory dysfunction (EjD). For the 320 patients who completed the DAN-PSSsex, alfuzosin treatment was associated with a significant improvement in the mean change from baseline in erectile function on day 29 compared with placebo (P=0.02). No significant difference was observed between the two treatment groups in the mean change from baseline in ejaculatory function on day 29. For patients with ED at baseline, a marginal improvement in erectile function was demonstrated with alfuzosin treatment (P=0.09 vs placebo). For patients with EjD at baseline, the mean change from baseline in ejaculatory function with alfuzosin was comparable to that with placebo. Dizziness was the most common adverse event with alfuzosin treatment (5 vs 0% with placebo), with other adverse events reported with comparable frequency in both treatment groups. After 1 month of treatment, alfuzosin 10 mg q.d. significantly improved erectile function in men with lower urinary tract symptoms/ benign prostatic hypertrophy and had no adverse effect on ejaculatory function.

Examination of the relationship between symptoms of prostatitis and histological inflammation: baseline data from the REDUCE chemoprevention trial

PURPOSE

Symptoms of abacterial chronic prostatitis/chronic pelvic pain syndrome are considered to be associated with prostate inflammation. The ongoing Reduction by Dutasteride of Prostate Cancer Events trial is a 4-year, phase III, placebo controlled study to determine whether 0.5 mg dutasteride daily decreases the risk of biopsy detectable prostate cancer. All men underwent biopsy before study entry, allowing review of the relationship between histological prostate inflammation and prostatitis symptoms.

MATERIALS AND METHODS

Eligible men were 50 to 75 years old with serum prostate specific antigen 2.5 ng/ml or greater and 10 ng/ml or less (ages 50 to 60 years), or 3.0 ng/ml or greater and 10 ng/ml or less (older than 60 years), and an International Prostate Symptom Score of less than 25 (or less than 20 if already on alpha-blocker therapy). Acute prostatitis was an exclusion criterion. The National Institutes of Health Chronic Prostatitis Symptom Index was used to assess prostatitis-like symptoms. Spearman rank correlations were used to assess the relationship between acute and chronic inflammation, and Chronic Prostatitis Symptom Index scores for the pain, urinary symptoms and quality of life domains as well as average pain, total score and prostatitis-like symptoms.

RESULTS

Data were available on 5,597 patients. The distribution of inflammation status was similar for those with and without chronic prostatitis-like symptoms. Significant correlations were found between average chronic inflammation, and total Chronic Prostatitis Symptom Index score and subscores for urinary symptoms and quality of life but the magnitude of these correlations was small.

CONCLUSIONS

A lack of clinically meaningful association was found between prostatitis-like pain symptoms and histological inflammation in the Reduction by Dutasteride of Prostate Cancer Events population, suggesting that the view that symptoms of chronic prostatitis/chronic pelvic pain syndrome and prostate inflammation are associated needs further scrutiny.

Prostate cancer disease-free survival after radical retropubic prostatectomy in patients older than 70 years compared to younger cohorts

OBJECTIVES

To evaluate the feasibility of radical retropubic prostatectomy (RRP) as an option for treating men older than 70 years with organ confined prostate cancer and to compare biochemical progression-free survival with younger cohorts.

MATERIALS AND METHODS

A total of 689 consecutive patients who were treated with RRP from 1994 to 2002 for clinically localized prostate cancer were categorized into 3 different age groups: younger than 50 years (n = 49), 50-70 years (n = 601), and older than 70 years (n = 39). Patients older than 70 years were healthy individuals for their age. Preoperative and postoperative cancer-specific characteristics were compared among these 3 groups.

RESULTS

There was no statistical significant difference among the 3 age strata in terms of clinical parameters (prostate-specific antigen, Gleason score, clinical stage, percent and number of positive biopsy cores) and pathologic findings (surgical margin, lymph node status, extracapsular extension, lymphovascular invasion, and pathologic Gleason score). The rate of seminal vesicle invasion and prostate volume increased with advancing age (P = 0.034 and P < 0.001). In multivariate logistic regression analysis, age was not associated with seminal vesicle invasion. The 5-year prostate-specific antigen progression-free estimates for patients younger than 50, 50-70, and older than 70 years were 82% (95% confidence interval [CI] 69% to 96%), 82% (95% CI 78% to 86%), and 65% (95% CI 43% to 86%), respectively (P = 0.349). The overall and cause-specific mortalities were not different.

CONCLUSIONS

RRP could be considered a standard treatment option in men older than 70 years with localized prostate cancer. Further studies are necessary to assess the survival benefit and health-related quality of life after radical prostatectomy versus watchful waiting in patients older than 70 years.

Dutasteride significantly improves quality of life measures in patients with enlarged prostate

The purpose of this study was to determine the effect of dutasteride on quality of life of men with lower urinary tract symptoms associated with enlarged prostate or benign prostatic hyperplasia (BPH) as measured by symptom problem index (SPI), BPH-specific interference with activities (BSIA), BPH-specific psychological well-being (BPWB) and BPH-specific lifestyle adaptations (BSLA). Data were derived from three randomized, double-blind studies conducted in 4325 men treated with placebo or dutasteride (0.5 mg/day). Primary analyses included changes from baseline in mean SPI, BSIA, BPWB and BSLA scores. Men treated with dutasteride showed significant improvements in SPI, BSIA, BPWB and BSLA scores compared with placebo.

Predicting the outcome of salvage radiation therapy for recurrent prostate cancer after radical prostatectomy

PURPOSE

An increasing serum prostate-specific antigen (PSA) level is the initial sign of recurrent prostate cancer among patients treated with radical prostatectomy. Salvage radiation therapy (SRT) may eradicate locally recurrent cancer, but studies to distinguish local from systemic recurrence lack adequate sensitivity and specificity. We developed a nomogram to predict the probability of cancer control at 6 years after SRT for PSA-defined recurrence.

PATIENTS AND METHODS

Using multivariable Cox regression analysis, we constructed a model to predict the probability of disease progression after SRT in a multi-institutional cohort of 1,540 patients.

RESULTS

The 6-year progression-free probability was 32% (95% CI, 28% to 35%) overall. Forty-eight percent (95% CI, 40% to 56%) of patients treated with SRT alone at PSA levels of 0.50 ng/mL or lower were disease free at 6 years, including 41% (95% CI, 31% to 51%) who also had a PSA doubling time of 10 months or less or poorly differentiated (Gleason grade 8 to 10) cancer. Significant variables in the model were PSA level before SRT (P < .001), prostatectomy Gleason grade (P < .001), PSA doubling time (P < .001), surgical margins (P < .001), androgen-deprivation therapy before or during SRT (P < .001), and lymph node metastasis (P = .019). The resultant nomogram was internally validated and had a concordance index of 0.69.

CONCLUSION

Nearly half of patients with recurrent prostate cancer after radical prostatectomy have a long-term PSA response to SRT when treatment is administered at the earliest sign of recurrence. The nomogram we developed predicts the outcome of SRT and should prove valuable for medical decision making for patients with a rising PSA level.

Quantifying the Impact of Prostate Volumes, Number of Biopsy Cores and 5α-Reductase Inhibitor Therapy on the Probability of Prostate Cancer Detection Using Mathematical Modeling

PURPOSE

Previous studies demonstrated a negative correlation between prostate volume and biopsy yield. By decreasing prostate volume 5alpha-reductase inhibitors may enhance cancer detection, which may explain the greater detection of high grade tumors in the finasteride arm of the Prostate Cancer Prevention Trial.

MATERIALS AND METHODS

A mathematical model was constructed to analyze the effects of prostate and tumor volumes, and biopsy core number on cancer detection. The effects of the volume reduction observed with finasteride in the Prostate Cancer Prevention Trial were also modeled, as was the potential reduction in tumor volume needed to explain the observed difference in prostate cancer detection. The model was also applied to the Reduction by Dutasteride of Prostate Cancer Events study.

RESULTS

A higher number of biopsies are required to ensure a detection probability of 0.90 or greater in larger glands or with smaller tumors. In the Prostate Cancer Prevention Trial for a tumor volume of 1 cc a 17% increase in the detection rate in the finasteride arm would be predicted if there was no change in tumor volume, likewise the rate would be 11% to 17% for the dutasteride arm of the Reduction by Dutasteride of Prostate Cancer Events study. The calculated reduction in tumor volume needed to explain the difference in cancer detection between the finasteride and placebo arms of the Prostate Cancer Prevention Trial would be 51% to 66%.

CONCLUSIONS

This model provides guidance on the optimal number of biopsy cores that accord with an earlier model. These findings also suggest that, if there were no reduction in tumor volume, 5alpha-reductase inhibitor therapy could lead to excess cancer detection, including high grade tumors.

Evidence-based validation of the predictive value of the American Association for the Surgery of Trauma kidney injury scale

BACKGROUND

To evaluate the predictive value of the American Association for the Surgery of Trauma (AAST) kidney injury scale for the management of traumatic renal injuries.

METHODS

From October 1995 through October 2004, 424 patients presented to our hospital with traumatic renal injury.

RESULTS

Overall, 27.8% of patients had grade I injury, 26.4% had grade II injury, 19.3% had grade III injury, 18.2% had grade IV injury, and 8.3% had grade V injury. Patient age, Glasgow Coma Scale score, Revised Trauma Score, creatinine, blood urea nitrogen (BUN), white blood count, gender, substance abuse, shock, flank ecchymosis, abdominal pain, and mortality were not associated with AAST grade. Systolic blood pressure and hematocrit levels decreased with increasing AAST grades (p = 0.032 and p = 0.045, respectively). Volume transfused and length of hospitalization increased with AAST grades (p = 0.003 and p = 0.004, respectively). Patients with gunshot injury had higher AAST grades than those with blunt trauma (p < 0.001). Hypotension (14%), blood transfusion (47%), gross hematuria (65.9%), and flank pain (25%) were associated with higher AAST grades (p = 0.010, p < 0.001, p = 0.016, and p = 0.001, respectively). Ninety patients (21.2%) underwent renal exploration: 61% nephrectomies and 39% renorraphies. In multivariable analyses, type of injury, hematuria at presentation, and AAST scale predicted the risk of renal exploration (p < 0.001, p = 0.024, and p < 0.001, respectively), whereas type of injury and AAST scale were the sole predictors of nephrectomy (p < 0.001 and p < 0.001, respectively).

CONCLUSIONS

We confirmed that the AAST injury severity scale is a powerful and valid tool for prediction of clinical outcome in patients with renal trauma.

Caveolin-1 overexpression is associated with aggressive prostate cancer recurrence

BACKGROUND

Caveolin-1 protein suppresses apoptotic cell death in prostate cancer. The objectives of this study were to investigate the association of Caveolin-1 expression with established features of prostate cancer as well as overall and aggressive disease recurrence in patients treated with radical prostatectomy (RP).

METHODS

Caveolin-1 immunostaining was performed on a tissue microarray containing prostatectomy specimen cores from 232 consecutive patients treated with RP for clinically localized prostatic adenocarcinoma. Caveolin-1 over-expression was defined as more than 50% of cells staining positively for Caveolin-1. Patients were categorized as having features of aggressive disease recurrence if they had a positive metastatic work-up, post-recurrence PSA doubling time less than 10 months, and/or failure to respond to local salvage radiation therapy.

RESULTS

Seventy patients (30.2%) exhibited over-expression of Caveolin-1. Caveolin-1 over-expression was associated with higher pathologic Gleason sum (P=0.038) and higher pre-operative PSA level (P=0.024). Patients with Caveolin-1 over-expression were at increased risk of PSA recurrence after surgery (P=0.023) in univariate but not in standard post-operative multivariate analysis. However, patients with Caveolin-1 over-expression were at increased risk of aggressive prostate cancer recurrence in both univariate and multivariate analysis (P<0.001 and P=0.001, respectively).

CONCLUSIONS

Over-expression of Caveolin-1 was associated with established features of prostate cancer and aggressive PSA recurrence. Caveolin-1 might help identify patients at high risk of developing aggressive prostate cancer recurrence, thus allowing selection of patients who might benefit from early systemic therapeutic intervention.

Tadalafil relieves lower urinary tract symptoms secondary to benign prostatic hyperplasia

PURPOSE

We assessed the efficacy and safety of tadalafil dosed once daily for lower urinary tract symptoms secondary to benign prostatic hyperplasia.

MATERIALS AND METHODS

Following a 4-week, single-blind, placebo run-in 281 men were randomly assigned (1:1) to 5 mg tadalafil for 6 weeks, followed by dose escalation to 20 mg for 6 weeks or 12 weeks of placebo.

RESULTS

Tadalafil significantly improved the mean change from baseline in International Prostate Symptom Score at 6 weeks (5 mg tadalafil -2.8 vs placebo -1.2) and at 12 weeks (5/20 mg tadalafil -3.8 vs placebo -1.7). Larger changes were observed with inclusion of the placebo run-in at 12 weeks (5/20 mg tadalafil -7.1 vs placebo -4.5). Significant improvements were also seen in the International Prostate Symptom Score irritative and obstructive domains, the International Prostate Symptom Score quality of life index, a question about urinary symptom improvement and the Benign Prostatic Hyperplasia Impact Index (significant at 12 weeks) vs placebo. International Prostate Symptom Score and International Index of Erectile Function erectile function domain scores significantly improved in the 56% of men with lower urinary tract symptoms/benign prostatic hyperplasia who were sexually active and had erectile dysfunction. Changes in uroflowmetry parameters were similar in the placebo and tadalafil groups. Commonly reported (2% or greater) treatment emergent adverse events were "erection increased," dyspepsia, back pain, headache, nasopharyngitis and upper respiratory tract infection (each 5.1% or less). No change in post-void residual volume was seen with tadalafil treatment.

CONCLUSIONS

Tadalafil once daily was well tolerated and demonstrated clinically meaningful and statistically significant symptomatic improvement for lower urinary tract symptoms/benign prostatic hyperplasia. Tadalafil also improved erectile function in men with lower urinary tract symptoms and erectile dysfunction.

The effect of dutasteride on the peripheral and transition zones of the prostate and the value of the transition zone index in predicting treatment response

PURPOSE

We determined the effects of dutasteride on transition and peripheral zone volume, and the clinical value of the transition zone index in men with benign prostatic hyperplasia.

MATERIALS AND METHODS

A total of 2,802 men 50 years or older with diagnosed benign prostatic hyperplasia, American Urological Association symptom index score 12 or greater, total prostate volume 30 cc or greater, prostate specific antigen 1.5 ng/ml or greater and 10 ng/ml or less, and peak urinary flow rate 15 ml per second or less were randomized to receive 0.5 mg dutasteride daily or placebo for 2 years. Total prostate and transition zone volume was measured with transrectal ultrasound at baseline and 4 times during the 2-year period. Peripheral zone volume (total prostate volume minus transition zone volume) and the transition zone index (transition zone volume/total prostate volume) were calculated. Patients were stratified into tertiles according to baseline total prostate and transition zone volume, and the transition zone index.

RESULTS

At 24 months dutasteride significantly decreased total prostate volume from baseline (p <0.0001). There were similar decreases in transition and peripheral zone volume (approximately 25%). In men receiving placebo high baseline total prostate and transition zone volume, and transition zone index were associated with poor 2-year outcomes, ie a low peak urinary flow rate, high American Urological Association symptom index scores, and an increased frequency of acute urinary retention and benign prostatic hyperplasia related surgery. Improvements in outcomes with dutasteride vs placebo were greatest in men with the highest baseline total prostate and transition zone volume, and transition zone index. In men with low (30 to less than 42 cc) and intermediate (42 to less than 58 cc) baseline total prostate volume the benefits of dutasteride therapy were only significant in the intermediate (0.4 to less than 0.55) and high (0.55 to less than 1.0) transition zone index tertiles.

CONCLUSIONS

Total prostate and transition zone volume, and the transition zone index are directly related to benign prostatic hyperplasia progression. The transition zone index may add value to transition zone volume alone for predicting outcomes. Dutasteride decreased transition and peripheral zone volume equally, supporting a known therapeutic role in benign prostatic hyperplasia and a possible preventive role in prostate cancer.

Use of combined apoptosis biomarkers for prediction of bladder cancer recurrence and mortality after radical cystectomy

BACKGROUND

Deregulation of apoptosis is a characteristic of human carcinogenesis. We aimed to investigate expression of the apoptosis markers Bcl-2, caspase-3, P53, and survivin and the association with oncological outcomes of patients treated by radical cystectomy and bilateral lymphadenectomy for urothelial-cell carcinoma of the bladder.

METHODS

Bcl-2, caspase-3, P53, and survivin immunostaining was undertaken on serial tissue microarrays containing cores from 226 consecutive patients (median follow-up 36.9 months [IQR 13.3-79.0]). 200 bootstrap resamples with replacement were done to reduce overfit bias and for internal validation.

FINDINGS

Expression of Bcl-2, caspase-3, P53, and survivin was altered in 73 (32%), 111 (49%), 120 (53%), and 141 (64%) patients, respectively. By univariate analysis, altered expression of Bcl-2, caspase-3, P53, and survivin were all associated with high probability of disease recurrence (hazard ratio 2.24 [95% CI 1.51-3.32], p<0.001; 1.73 [1.16-2.59], p=0.007; 2.70 [1.77-4.12], p<0.001; and 2.32 [1.48-3.63], p<0.001) and disease-specific mortality (2.06 [1.33-3.18], p=0.001; 2.35 [1.48-3.73], p<0.001; 3.23 [1.98-5.28], p<0.001; and 2.64 [1.57-4.44], p<0.001; respectively). Risk of recurrence and disease-specific mortality progressively grew with increasing number of altered biomarkers. By multivariate analysis, alteration of four markers was independently associated with high rates of disease recurrence (4.03 [1.23-13.16], p=0.021) and disease-specific mortality (6.84 [1.43-32.63], p=0.016). Addition of the number of altered markers to a model that included standard predictors significantly enhanced its predictive accuracy for disease recurrence and disease-specific survival.

INTERPRETATION

Bcl-2, caspase-3, P53, and survivin have a cooperative effect on progression of bladder cancer. Assessment of combined apoptosis marker status and number of altered markers in patients treated by radical cystectomy provides prognostic information that could help to identify those at high risk for disease recurrence and mortality, who could benefit from early adjuvant treatment.

Association of the circulating levels of the urokinase system of plasminogen activation with the presence of prostate cancer and invasion, progression, and metastasis

PURPOSE

To assess whether preoperative plasma levels of urokinase-type plasminogen activator (uPA) and its soluble receptor (uPAR) would predict cancer of the prostate (CaP) presence, stage, and prognosis.

PATIENTS AND METHODS

Plasma levels of uPA and uPAR were measured in patients who underwent radical prostatectomy for clinically localized CaP (preoperative, n = 429; postoperative, n = 76), 44 healthy men, 19 patients with metastases to regional lymph nodes, and 10 patients with bone metastases.

RESULTS

uPA and uPAR levels were significantly elevated in patients with CaP compared with healthy men and significantly declined after prostate removal. In CaP patients, uPA and uPAR levels both increased significantly from patients with nonmetastatic CaP to patients with lymph node metastases to patients with skeletal metastases. On univariate analysis, preoperative uPA and uPAR levels were significantly elevated in patients with extracapsular extension, seminal vesicle involvement, higher prostatectomy Gleason sum, lymph node invasion, lymphovascular invasion, perineural invasion, and higher tumor volume. Higher preoperative uPAR was associated with biochemical progression in univariate analysis. Conversely, higher preoperative uPA was independently associated with biochemical progression in preoperative or postoperative multivariate models. In patients with biochemical progression, preoperative uPA and uPAR were both significantly associated with shorter postprogression total serum prostate-specific antigen doubling times, failure to respond to salvage local radiation therapy, and/or development of distant metastasis.

CONCLUSION

Elevation of plasma uPA and uPAR levels in CaP patients seems to be partly caused by local release from the prostate. Plasma levels of uPA and uPAR are associated with features of biologically aggressive CaP, disease progression after radical prostatectomy, and metastasis.

Anthropometric and metabolic factors and risk of benign prostatic hyperplasia: a prospective cohort study of Air Force veterans

OBJECTIVES

The relationship between anthropometric and metabolic factors and benign prostatic hyperplasia (BPH) is poorly understood. We investigated the associations of BPH with anthropometric and metabolic parameters in this prospective study of Vietnam War veterans.

METHODS

A total of 1206 participants in the comparison arm of the Air Force Health Study with a median follow-up of 15.6 years were included in this study. The "Ranch Hand" group, occupationally exposed to herbicides, was excluded to eliminate any confounding from exposure to herbicides. BPH was determined by medical record review using the International Classification of Diseases and Related Problems, Ninth Revision. We used Cox proportional hazards regression models for the statistical analysis.

RESULTS

The median age for BPH diagnosis was 58.6 years. On multivariate analyses, increasing age (relative risk [RR] 1.14, 95% confidence interval [CI] 1.12 to 1.17), height (RR 1.02, 95% CI 1.004 to 1.03), and fasting blood glucose (RR 1.004, 95% CI 1.001 to 1.007) were associated with increased risk. The effect of age varied with the duration of follow-up. A greater systolic blood pressure (RR 0.992, 95% CI 0.986 to 0.997) was associated with decreased risk of BPH. A dose-response effect was seen for age, height, and systolic blood pressure. No effect was seen for weight, body mass index, change in weight or body mass index, lipids, thyroid hormone status, or the metabolic syndrome.

CONCLUSIONS

The risk of BPH increased with increasing age, height, and fasting blood glucose levels. The risk was decreased with a greater systolic blood pressure. No relationship was seen between BPH and metabolic syndrome, weight, body mass index, lipid level, or thyroid hormone status.

Rapid onset of action with alfuzosin 10 mg once daily in men with benign prostatic hyperplasia: a randomized, placebo-controlled trial

This randomized, double-blind, placebo-controlled study was conducted to investigate whether alfuzosin 10 mg once daily improves the maximum flow rate (Q(max)) and lower urinary tract symptoms (LUTS) of benign prostatic hyperplasia (BPH) after 1 week and 1 month of treatment. A total of 372 men aged > or = 50 years with symptomatic BPH received alfuzosin or placebo for 28 days. Q(max) increased significantly from baseline at day 8 with alfuzosin (P<0.001 versus placebo); this improvement was evident within 24 h after the first dose and was maintained at day 29. LUTS improved from baseline with alfuzosin at day 8 (P=0.07 versus placebo) and day 29 (P=0.003 versus placebo). Alfuzosin 10 mg once daily exhibits a rapid onset of action, with improvements in Q(max) and LUTS maintained through 1 month of treatment.

Effect of 1 mg/day finasteride on concentrations of serum prostate-specific antigen in men with androgenic alopecia: a randomised controlled trial

BACKGROUND

Use of 5 mg/day finasteride (Proscar) for benign prostatic hyperplasia is known to affect serum concentrations of prostate-specific antigen (PSA). When men taking this treatment undergo screening for prostate cancer, a compensatory adjustment of the PSA concentration (to multiply the value by two) is recommended. Whether this recommendation should apply to men taking 1 mg/day finasteride (Propecia) for the treatment of androgenic alopecia is unknown. We aimed to assess the effect of 1 mg/day finasteride on serum PSA in men aged 40-60 years with male-pattern hair loss.

METHODS

Between March 13, 1998, and Jan 12, 2000, 355 men aged 40-60 years with male-pattern hair loss were stratified by age decade (40-49 years and 50-60 years), and randomised in a ratio of four to one to 1 mg/day finasteride or placebo. The primary endpoint was the effect of this treatment for 48 weeks on serum PSA concentration compared with placebo. This trial is in the process of being registered on the US National Institutes of Health website . Analyses were according to protocol.

FINDINGS

Within 48 weeks of randomisation, men aged 40-49 years and 50-60 years who were assigned 1 mg/day finasteride had a median decrease in serum PSA concentration of 40% (95% CI 34-46) and 50% (44-57), respectively. In men assigned placebo, the median changes were 0% [-14 to 14] and a median increase of 13% [2 to 24], respectively.

INTERPRETATION

In men aged 40-60 years, 1 mg/day finasteride for 48 weeks lowers serum PSA concentration. Therefore, the existing recommendation for the adjustment of serum PSA concentration in prostate-cancer screening in men taking 5 mg/day finasteride should also apply to men taking the 1 mg/day preparation for male-pattern hair loss. Research is needed to assess the effect of 1 mg/day finasteride preparation beyond 48 weeks of treatment.