San Francisco, CA, June 1, 2010–5-Alpha reductase inhibitors (5-ARI), such as finasteride and dutasteride, may increase the specificity of the prostate-specific antigen (PSA) test in men with elevated or fluctuating PSA levels and previous negative biopsy, according to new data from researchers from NewYork-Presbyterian Hospital/Weill Cornell Medical Center in New York City. Investigators, who will present the data during the upcoming 105th Annual Meeting of the American Urological Association (AUA), postulate that PSA velocity while undergoing 5-ARI therapy can be a useful diagnostic adjunct for detection of prostate cancer. These data will be presented to the press during a special press conference on June 1, 2010 at 1 p.m. PDT. Prostate cancer expert William Catalona, MD, will moderate the session for the media.
Researchers studied 275 men with prior negative prostate cancer biopsy to determine potential changes in prostate-specific antigen (PSA) levels after the men took 5-ARIs for six months and again after one year. Men in the study, on average, had already had two negative biopsies and an average baseline PSA was 5.15 ng/ml. Investigators found that after six months of taking a 5-ARI, men with a PSA velocity (PSAV) change of more than or equal to 0.4 ng/ml were also found to have cancer on repeat biopsy. At one-year follow-up, the same pattern held true—men with a PSA velocity of more than or equal to 0.4 ng/ml were found to have cancer and most of these men had high-grade (Gleason score above 7) cancer. This data suggests that a PSA velocity change of 0.4 ng/ml is a cut-off point for detecting high-grade prostate cancer in men who have taken a 5-ARI for at least six months and have had a prior negative biopsy.
“Taking 5-ARI drugs may eliminate the background noise associated with PSA testing—canceling out a benign response and leaving only one signal for malignancy,” explains Dr. Steven Kaplan, lead author and attending urologist at New York-Presbyterian Hospital/Weill Cornell Medical Center. “We may now be able to distinguish prostate cancer from benign prostatic hyperplasia (BPH) disease.”
“These studies mark the beginning of a new diagnostic approach to prostate-specific antigen,” said William Catalona, MD, who moderated the session. “One day, after more research is conducted, we may use PSA velocity to determine which cancers will need treatment. This will alleviate so many of the difficult decisions and obstacles faced by physicians and patients alike.”
NOTE TO REPORTERS: Experts are available to discuss this study outside normal briefing times. To arrange an interview with an expert, please contact the AUA Communications Office at the number above or e-mail Communications@AUAnet.org.
About the American Urological Association: Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is the pre-eminent professional organization for urologists, with more than 16,000 members throughout the world. An educational nonprofit organization, the AUA pursues its mission of fostering the highest standards of urologic care by carrying out a wide variety of programs for members and their patients.
Wendy Isett, AUA