Can effect of finasteride on prostate-specific antigen be used to decrease repeat prostate biopsy?

Area of Science:

• Urology
• Oncology
• Pharmacology

Background:

• Elevated prostate-specific antigen (PSA) levels often necessitate repeat prostate biopsies.
• Finasteride is known to reduce serum PSA levels by approximately 50%.

Purpose of the Study:

• To investigate the correlation between finasteride, PSA, and PSA density (PSAD).
• To identify potential criteria for excluding patients from repeat prostate biopsies based on finasteride response.

Main Methods:

• A prospective pilot study involving 25 men with elevated PSA and prior negative biopsies.
• Measurements of PSA and PSAD at baseline, followed by 6 months of finasteride treatment.
• Repeat PSA, PSAD measurements, and prostate biopsies after 6 months.

Main Results:

• The median PSA decreased from 8.3 to 4.6 ng/dL, and median PSAD from 0.18 to 0.09.
• Of 23 completers, 6 (26%) were diagnosed with prostate cancer.
• Patients without cancer showed a 44% PSAD decrease, while those with cancer had a 5% decrease.

Conclusions:

• Finasteride treatment resulted in a significantly greater decrease in PSAD among patients without prostate cancer.
• This suggests finasteride's effect on PSAD may aid in selecting patients for repeat biopsy.
• A larger prospective study is warranted due to the pilot nature and small sample size.