PSA, 5-ARIs help identify hard-to-diagnose PCa

Researchers from New York-Presbyterian Hospital/Weill Cornell Medical Center in New York have successfully developed and tested a new prostate cancer screening method.

The technique combines novel drug therapy and changes in PSA levels over time to identify men with a high PSA who are more likely to have aggressive prostate cancer despite negative biopsies.

The study, which was published in the Journal of Urology (2012; 188:757-61), shows that PSA can be a much more effective marker for prostate cancer when an additional drug therapy is used.

"At a time when the value of PSA is being increasingly debated, we have shown that when used in a specific way, it can be of great value in identifying men with previously undetected prostate cancer," said lead investigator Steven A. Kaplan, MD. "We have shown that using PSA with these drugs can help us differentiate prostate cancer from benign prostate disease in patients who are difficult to diagnose."

The study was conducted in two phases and enrolled 276 men at New York-Presbyterian/Weill Cornell who had a PSA greater than 4.0 ng/mL, a normal digital rectal examination, and two or more negative biopsies.

In the first phase, 97 patients, who were given the 5-alpha reductase inhibitor finasteride (Proscar), 5 mg daily, or dutasteride (Avodart), 0.5 mg daily, had their PSA measured at 6 and 12 months, a transrectal ultrasonography, and a biopsy performed at 1 year. Study results show that 1 year of the drug therapy reduced PSA in all the men-an average of 48%-but the magnitude of reduction was significantly greater in men with benign prostate disease and significantly less in 28% of the patients whose prostate biopsy detected cancer.

In the second phase of the study, 179 patients received the same drug therapy but underwent a biopsy only if their PSA showed a change of 0.4 ng/mL. In all, 42 men (27%) had the biopsy, and 26 of those participants (54%) had cancer. Within that group, 77% of the patients had high-grade tumors.

The authors successfully identified cancer cases in men who participated in the second phase of the study with the combined drug therapy and evaluation of PSA trends by sending those with minimal changes for a biopsy. This meant that men who didn’t need a biopsy did not have one, unlike all the men in the first phase.

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