Clinicians can safely treat benign prostatic hyperplasia (BPH) with finasteride or dutasteride in men on active surveillance for very-low-risk prostate cancer (PCa), according to a new study.
Of 82 patients in the study, 57 (70%) maintained very-low-risk PCa or had negative follow-up biopsies during a three-year follow-up period, investigators reported online ahead of print in Urology.
The study, by Peter Q. Shelton, MD, and colleagues at Carolinas Medical Center in Charlotte, N.C., included 82 patients with very-low-risk PCa—defined as clinical stage T1c, Gleason score of 6 or less, fewer than three biopsy cores positive with 50% or less involvement, and PSA density of 0.15 or less—and BPH (prostate volume 30 cm3 or greater). All received treatment with a 5ɑ-reductase inhibitor (5-ARI)—either finasteride or dutasteride. Twenty-two patients (27%) underwent treatment for PCa.
Restaging biopsies were performed on 76 patients, of whom 41 (54%) had no PCa, 16 (21%) continued to have very-low-risk PCa, 15 (20%) had progressed to low-risk PCa (more than two cores positive and Gleason score of 6 or less), and four (5%) had progressed to intermediate-risk PCa (Gleason score of 7). During the study period, the cohort had an average 19% decrease in prostate volume. At the end of the study period, 29 patients had stopped taking their 5-ARI.
“Because BPH is commonly seen in conjunction with PCa, it is important to understand the influence of 5-ARI therapy on very-low-risk, low-volume PCa,” the authors observed.