PCPT, MTOPS and the use of 5ARIs: a Canadian consensus regarding implications for clinical practice

Two large, recently published, definitive trials evaluated the benefits of 5-alpha reductase inhibitors (5ARIs). The Prostate Cancer Prevention Trial (PCPT) tested the effect of finasteride for prostate cancer prevention and the Medical Therapy of Prostatic Symptoms (MTOPS) tested its effect in benign prostatic hyperplasia (BPH). Both trials were strongly positive. However, the role of 5ARIs in the clinical management of patients remains controversial. The consensus conference, which forms the basis for this report, attempted to develop an expert opinion, based on these studies, as to the optimal use of 5ARIs in patient management.

The Canadian Consensus Meeting, organized by the Canadian Urology Research Consortium and the Canadian Urologic Oncology Group, held in Toronto on May 7, 2006, focused on the new data from the PCPT and the MTOPS study. Internationally recognized experts and clinicians discussed the implications of these data on clinical practice and issued a recommendation on the optimal management of patients with BPH.

The Consensus meeting agreed on the following recommendations: The overall results from the PCPT and MTOPS studies are of importance to the urologic, as well as to the greater medical, community.Prostate management guidelines should be updated to include the results from both the MTOPS and the PCPT studies.In the PCPT, the incidence of high-grade cancer was higher in the finasteride-treated group (6.4%), compared with the placebo group (5.1%). Subsequent analyses strongly suggest that this increased prevalence was owing to a detection bias caused by the reduction in prostate volume in patients taking finasteride, compared with patients taking placebo. This resulted in an improved detection at biopsy of high-grade cancer in the finasteride group.In men who have large prostates and lower urinary tract symptoms (LUTS), 5ARIs( section sign) should be considered, both for the treatment of BPH and for prostate cancer risk reduction.For men who are concerned about prostate cancer, it is appropriate to discuss chemoprevention with finasteride.Urologists are encouraged to disseminate these recommendations among other healthcare professionals.