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Povidone Iodine Rectal Preparation at Time of Prostate Needle Biopsy is a Simple and Reproducible Means to Reduce Risk of Procedural Infection

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

Liann Nicole Handel¹, Saurabh Agarwal, Stephen F Schiff

¹Department of Urology, Brown University/Roger Williams Medical Center, Providence, Rhode Island 02904, USA.

|December 5, 2006

Summary

Finasteride use in men with elevated prostate-specific antigen (PSA) and prior negative biopsies showed decreased PSA density (PSAD). Patients without prostate cancer experienced a greater PSAD reduction, suggesting finasteride may help identify men who can avoid repeat prostate biopsy.

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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.