Primary care physician knowledge of 5-ARIs’ effects on PSA is low

Investigators presenting at the 2024 Sexual Medicine Society of North America Fall Scientific Meeting in Scottsdale, Arizona identified a lack of knowledge among primary care physicians (PCPs) regarding the effect of 5-α-reductase inhibitors (5-ARIs) on prostate-specific antigen (PSA) kinetics.¹

Justin Loloi, MD

This could affect prostate biopsy referrals in patients taking these medications, according to findings from a survey of PCPs presented by Justin Loloi, MD, a urology resident at Montefiore Medical Center in Bronx, New York.

In their abstract, Loloi and his colleagues explained that PCPs are frequent prescribers of 5-ARIs for benign prostatic hyperplasia (BPH). 5-ARIs can potentially decrease PSA levels by approximately half. This can lead to delays in diagnosis of prostate cancer.

“Our team previously presented preliminary findings revealing a general low level of knowledge regarding the effects of 5-ARIs on PSA kinetics. Thus, the objective of this study is to now present further, expanded data investigating PCPs’ level of awareness and indications of 5 ARI use for BPH in the primary care setting,” wrote the authors.

For the current study, after IRB approval, the investigators emailed an anonymous 14-question to PCPs specializing in family medicine or internal medicine who were employed by a diverse, urban, academic institution. Topics covered by the questions included “residency graduation year, patient volume, medical practice characteristics, knowledge of 5-ARIs and their effects on PSA kinetics, role of 5-ARIs in [prostate cancer] prevention, and indications for prostate biopsy referral,” according to the authors.

Out of 221 PCPs who were emailed, 85 responded, yielding a response rate of 38.5%. Of the respondents, 38 (45%) had graduated residency before 2010 and 47 (55%) graduated after 2010. More than 95% of respondents reported that they saw at least 1 patient with BPH or prostate cancer every year. In addition, a majority of the respondents (86%) reported ordering at least 1 PSA test. More than half (56%) said that they had “referred at least 1 patient for a prostate biopsy every 3 to 6 months,” according to the authors.

The investigators reported that approximately 80% of respondents had prescribed 5-ARIs for BPH. “There were no significant differences in the knowledge of 5-ARIs and their effects on PSA, role of 5-ARIs in [prostate cancer prevention], or indications for prostate biopsy referral between PCPs who graduated residency before 2010 and after 2010, or between PCPs who were family medicine physicians and internists (P <. 05 for all),” the authors wrote.

For the survey question “Do 5-ARIs reduce serum PSA?” 8 (9.4%) respondents said “no” and 25 (29.4%) said “not sure.” When asked “If a man with BPH, who is on a 5-ARI for one year, has a PSA of 2.4 ng/mL, what is approximately his true PSA?” 31 (36.5%) respondents said 4.8 ng/mL. For the question “If all other things normal, would you refer the above patient for a prostate biopsy?” 38 (44.7%) PCPs said “no” and 28 (32.9%) said “not sure.”

In their conclusion, the authors said the findings “may represent an important initiative to work with our primary care colleagues in caring for patients taking 5-ARIs for BPH.”

REFERENCE

1. Loloi J, Alicea D, Babar M, et al. Physician awareness and indications of 5-alpha reductase inhibitor use for benign prostatic hyperplasia in the primary care setting. Presented at: 2024 Sexual Medicine Society of North America Fall Scientific Meeting. October 17-20, 2024. Scottsdale, Arizona. Abstract 218