[Practical follow-up of a patient treated with finasteride in screening for prostate cancer]

The following conclusions can be made on the practical follow up of a patient receiving finasteride in screening for prostate cancer from an analysis of the literature and, particularly, the Prostate Cancer Prevention Trial (PCPT). Prostate volume fells by an average of 17 to 19%. The average fall in PSA after one year of finastéride treatment was 50%. This fall continued over time, at an average of 5% per year. An adjustment factor of x 2 at 1 year was used to return to a PSA value of a group of untreated men. The ratios of free PSA/total PSA and complexed PSA/total PSA remained unchanged and were interpreted as usual. The risk of cancer was low if the PSA fell by > or = 50% and raised if it fell by < 33%. Prostate cancer was associated with an average 15% rise in PSA on finasteride. This change still needs to be validated. The sensitivity of PSA and rectal examination was greater in detecting all grades of cancer in people receiving finasteride than on placebo. These findings have the benefit of reducing the indications for biopsy during follow up. Finasteride does not appear to cause high grade cancers. Despite the 25% reduction in the risk of cancer on finasteride there was insufficient information, particularly on the impact on mortality to allow chemoprevention to be proposed. Patients started on finasteride to treat BPH must be informed of the possible benefits, side effects and follow up arrangements to screen for prostate cancer.