Prostate-Specific Antigen Kinetics Following 5α-Reductase Inhibitor Treatment May Be a Useful Indicator for Repeat Prostate Biopsy.
10.3349/ymj.2018.59.2.219
- Author:
Ji Eun HEO
1
;
Kyo Chul KOO
;
Sung Joon HONG
;
Sang Un PARK
;
Byung Ha CHUNG
;
Kwang Suk LEE
Author Information
1. Department of Urology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. winner0428@gmail.com
- Publication Type:Original Article ; Evaluation Studies
- Keywords:
Prostate biopsy;
prostate-specific antigen;
5α-reductase inhibitors
- MeSH:
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
- From:Yonsei Medical Journal
2018;59(2):219-225
- CountryRepublic of Korea
- Language:English
-
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.
