Finasteride in prevention of prostate cancer progration

Authors

  • Е. О. Стаховський Национальный институт рака
  • Ю. В. Вітрук Национальный институт рака
  • О. А. Войленко Национальный институт рака
  • О. Е. Стаховський Национальный институт рака
  • П. С. Вукалович Национальный институт рака
  • Р. А. Литвиненко Национальный институт рака
  • М. В. Пікуль Национальный институт рака
  • О. В. Буйвол Национальный институт рака
  • К. В. Богдан Национальный институт рака

DOI:

https://doi.org/10.30841/2307-5090.4(55).2015.104611

Keywords:

prostate cancer, active surveillance, 5α reductase inhibitors

Abstract

Inhibitors of 5α reductase suppress the conversion of testosterone to the more active form – dihydrotestosterone, resulting in the reduction of proliferation of both benign and malignant prostate tissue; can thus slow the progression of the disease during active surveillance for patients with prostate cancer.

Objective aim. Improve the efficiency of the treatment of prostate cancer at low risk that is under active surveillance by using 5α reductase inhibitors.

Materials and methods. Results of treatment of 96 patients with prostate cancer at low risk, combined with benign prostatic hyperpla sia that were under active surveillance from 2008 to 2015 to reduce the risk of disease progression and reduce symptoms of lower urinary tract in all patients prescribed finasteride (Proscar, Prostan) at a dose of 5 mg a day. We determined the time to prostate specific antigen (PSA) and histological progression analysis the number of patients who underwent radical treatment, and the impact of treatment on prostate size and the quality of life of patients.

Results. The period of observation of patients ranged from 12 to 86 months (46,2 ± 33,6). Despite no evidence of disease progression, refused to conduct further active observation during the first two years, 11 (11.5%) patients. Average time to disease progression by PSA level was 32.2 months. According to histological study, progression was diagnosed in 16 (16.7%) with an average attack time to progres sion – 38.4 months. 62 (64.6%) patients continue to be under the active supervision of the average duration – 46.2 months. In 26 (27.1) patients who went out from under active surveillance by choice or due to disease progression, subsequently conducted a radical treatment (radical prostatectomy or radiation therapy). The use of inhibitors of 5α reductase led to a reduction in the size of the prostate by 23%, improving urination and, consequently, the quality of life of patients.

Conclusion. The use of inhibitors of 5α reductase during active sur veillance for patients with prostate cancer at low risk prostate volume reduced by 23%, improve the sensitivity of PSA, prostate biopsy and digital rectal examination. Patients with prostate cancer who use inhibitors of 5α reductase have a lower rate of progression (16.7%) and less likely to abandon active surveillance (11.5%).

Author Biographies

Е. О. Стаховський, Национальный институт рака

E. Stakhovsky

Ю. В. Вітрук, Национальный институт рака

I. Vitruk

О. А. Войленко, Национальный институт рака

O. Voylenko

О. Е. Стаховський, Национальный институт рака

O. Stakhovskyi

П. С. Вукалович, Национальный институт рака

P. Vukalovych

Р. А. Литвиненко, Национальный институт рака

R. Lytvynenko

М. В. Пікуль, Национальный институт рака

M. Pikul

О. В. Буйвол, Национальный институт рака

O. Buyvol

К. В. Богдан, Национальный институт рака

K. Bohdan

References

Рак в Україні, 2013–2014: захворюваність, смертність, показники діяльності онкологічної служби / під ред. О.О. Колеснік // Бюл. національного канцер реєстру України. – 2015. – No 16. – 104 с.

Prostate cancer mortality at 11 years of follow up / F. Schroder, J. Hugosson, M. Roobol [et al.] // N. Engl. J. Med. – 2012. – Vol. 366. – P. 981–990.

Mortality results from a randomized prostate cancer screening trial / G. Andriole, E. Crawford, R. Grubb III [et al.] // N. Engl. J. Med. – 2009. – Vol. 360. – P. 1310–1319.

Welch H. Overdiagnosis in cancer / H. Welch, W. Black // J. Natl. Cancer Inst. – 2010. – Vol. 102. – P. 605–613.

Active surveillance in men with localized prostate cancer: A systematic review / I. Dahabreh, M. Chung, E. Balk [et al.] // Ann. Intern. Med. – 2012. – Vol. 156. – P. 582–590.

Active surveillance for low risk prostate cancer worldwide: The PRIAS study / M. Bul, X. Zhu, R. Valdagni [et al.] // Eur. Urol. – 2013. – Vol. 63. – P. 597–603.

Moyer V. US preventive services task force. Screening for prostate cancer: US preventive services task force recommendation statement / V. Moyer // Ann. Intern. Med. – 2012. – Vol. 157. – P. 120–134.

Clinical results of long term follow up of a large, active surveillance cohort with localized prostate cancer / L. Klotz, L. Zhang, A. Lam [et al.] // J. Clin. Oncol. – 2010. – Vol. 28. – P. 126–131.

Predicting the probability of deferred radical treatment for localised prostate cancer managed by active surveillance / N. van As, A. Norman, K. Thomas [et al.] // Eur. Urol. – 2008. – Vol. 54. – P. 1297–1305.

Active surveillance program for prostate cancer: an update of the Johns Hopkins experience / J. Tosoian, B. Trock, P. Landis [et al.] // J. Clin. Oncol. – 2011. – Vol. 29. – P. 2185–2190.

Active surveillance for the management of prostate cancer in a contemporary cohort / M. Dall’Era, B. Konety, J. Cowan [et al.] // Cancer. – 2008. – Vol. 112. – P. 2664–2670.

Careful selection and close monitoring of low risk prostate cancer patients on active surveillance minimizes the need for treatment / M. Soloway, C. Soloway, A. Eldefrawy [et al.] // Eur. Urol. – 2010. – Vol. 58. – P. 831–835.

Compliance rates with the Prostate Cancer Research International Active Surveillance (PRIAS) protocol and disease reclassification in noncompliers / L. Bokhorst, A. Alberts, A. Rannikko [et al.] // Eur. Urol. – 2015. – Vol. 68. – P. 814–821.

Active surveillance for the management of localized prostate cancer: Guideline recommendations / C. Morash, R. Tey, C. Agbassi [et al.] // Can. Urol. Assoc. J. – 2015. – Vol. 9. – P. 171–178.

Surgical management after active surveillance for low risk prostate cancer: Pathological outcomes compared with men undergoing immediate treatment / M. Dall’Era, J. Cowan, J. Simko [et al.] // BJU Int. – 2010. – Vol. 107. – P. 1232–1237.

Pathological findings at radical prostatectomy in patients initially managed by active surveillance: A comparative analysis / V. Iremashvili, M. Manoharan D. Rosenberg [et al.] // Prostate. – 2012. – Vol. 72. – P. 1573–1579.

Pathological findings at radical prostatectomy in Japanese prospective active surveillance cohort / M. Sugimoto, T. Shiraishi, H. Tsunemori [et al.] // Jpn. J. Clin. Oncol. – 2010. – Vol. 40. – P. 973–979.

Delayed versus immediate surgical intervention and prostate cancer out come / C. Warlick, B. Trock, P. Landis [et al.] // J. Natl. Cancer Inst. – 2006. – Vol. 98. – P. 355–357.

Prospective study of antibiotic prophylaxis for prostate biopsy involving > 1100 men / R. Manecksha, G. Nason, M. Cullen [et al.] // Scientific World Journal. – 2012. – Vol. 2012. – Art. ID650858. – 4 pages.

Management options for low risk prostate cancer: a report on comparative effectiveness and value / D. Ollendorf, J. Hayes, P. McMahon [et al.] // Institute for Clinical and Economic Review, Boston. – 2010. – 76 P.

Efficacy and safety of a dual inhibitor of 5 alpha reductase types 1 and 2 (dutasteride) in men with benign prostatic hyperplasia / C. Roehrborn, P. Boyle, J. Nickel [et al.] // Urology. – 2002. – Vol. 60. – P. 434-441.

Comparison of dutasteride and finasteride for treating benign prostatic hyperplasia: the Enlarged Prostate International Comparator Study (EPICS) / J. Nickel, P. Gilling, T. Tammela [et al.] // BJU Int. – 2011. – Vol. 108. – P. 388-394.

Thelong term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign pro static hyperplasia / J. McConnell, C. Roehrborn, O. Bautista [et al.]// N. Engl. J. Med. – 2003. – Vol. 349. – P. 2387-2398.

Efficacy and tolerability of doxazosin and finasteride, alone or in combination, in treatment of symptomatic benign prostatic hyperplasia: the Prospective European Doxazosin and Combination Therapy (PREDICT) trial / R. Kirby, C. Roehrborn, P. Boyle [et al.] // Urology. – 2003. – Vol. 61. – P. 119-126.

The effects of combination therapy with dutasteride and tamsulosin on clinical outcomes in men with symptomatic benign prostatic hyperplasia: 4 year results from the CombAT study / C. Roehrborn, P. Siami, J. Barkin [et al.] // Eur. Urol. – 2010. – Vol. 57. – P. 123-131.

Association of clinical benign prostate hyperplasia with prostate cancer incidence and mortality revisited: a nationwide cohort study of 3009258 men / D. Orsted, S. Bojesen, S. Nielsen [et al.] // Eur. Urol. – 2011. – Vol. 60 (4). – P. 691–698.

Prostate carcinoma risk subsequent to diagnosis of benign prostatic hyperplasia: a population based cohort study in Sweden / A. Chokkalingam, O. Nyren, J. Johansson [et al.] // Cancer. – 2003. – Vol. 98 (8). – P. 1727–1734.

Hormones and prostate cancer: current perspectives and future directions / A. Hsing, J. Reichardt, F. Stanczyk // Prostate. – 2002. – Vol. 52. – P. 213–235.

Alpha reductase activity and risk of prostate cancer among Japanese and US white and black males / R. Ross, L. Bernstein, R. Lobo [et al.] // Lancet. – 1992. – Vol. 339. – P. 887–889.

Steers W. 5 alpha reductase activity in the prostate / W. Steers // Urology. – 2001. – Vol. 58. – P. 17–24.

Dual 5 alpha reductase inhibitor dutasteride induces atrophic changes and decreases relative cancer volume in human prostate / K czkowski, J. Qiu, M. Somerville [et al.] // Urology. – 2005. – Vol. 65. – P. 76–82.

The influence of finasteride on the development of prostate cancer / I. Thompson, P. Goodman, C. Tangen [et al.] // N. Engl. J. Med. – 2003. – Vol. 349. – P. 215–224.

Long term follow up of a large active surveillance cohort of patients with prostate cancer / L. Klotz, D. Vesprini, P. Sethukavalan [et al.] // J. Clin. Oncol. – 2015. – Vol. 33. – Р. 272–277.

Guidelines on prostate cancer / N. Mottet, E. Bellmunt, R. van den Bergh [et al.] // European Association of Urology Guidelines. – EAU, 2015. – P. 1–137.

Differential expression of 5-alpha reductase isozymes in the prostate and its clinical implications / K. Wang, D. Fan, S. Jin [et al.] // Asian J. Andrology. – 2014. – Vol. 16. – P. 274–279.

Porten S. The independent value of tumour volume in a contemporary cohort of men treated with radical prostatectomy for clinically localized disease / S. Porten, M. Cooperberg, P. Carroll // B. J. U. Int. – 2010. – Vol. 105. – P. 472–475.

Should pathologists routinely report prostate tumor volume? The prognostic value of tumor volume in prostate cancer / T. Wolters, M. Roobol, P. van Leeuwen [et al.] // Eur. Urol. – 2010. – Vol. 57. – P. 821–829.

Klotz L. Active surveillance for prostate cancer: for whom? / L. Klotz // J. Clin. Oncol. – 2005. – Vol. 23. – P. 8165–8169.

National Prostate Cancer Register of Sweden. Outcome of primary vs deferred radical prostatectomy in the National Prostate Cancer Register of Sweden Follow Up Study / B. Holmstrцm, E. Holmberg, L. Egevad [et al.] / J. Urol. – 2010. – Vol. 184 (4). – P. 1322–1327.

Published

2015-12-19

Issue

Section

For practicing physicians