[5ARI and PSA: therapeutic aspects]

PSA modifications can be determined not only by the presence of a prostate neoplasm but also by other benign diseases such as inflammation and benign prostatic hyperplasia (BPH).

In cases with progressive BPH under 5 alpha reductase inhibitors, we obtain a reduction of the risk to receive unnecessary prostate biopsies (related to an increase of PSA secondary to a progressive BPH). On the contrary, BPH patients in progression with an elevated PSA level, under monotherapy with alpha1 blockers, continue to have PSA modifications related to benign prostatic diseases, increasing the risk of other unnecessary biopsies for prostate neoplasm diagnosis.

During 5 alpha reductase inhibitors, the reduction and the following stabilization of PSA levels to a new nadir value exclude the need of new evaluations or biopsies for the early diagnosis of prostate cancer. On the contrary, a confirmed increase of PSA levels over the nadir is associated with the risk of a clinically relevant prostate neoplasm and therefore it induces a bioptic procedure.