UroToday- In the May, 2007 issue of the Journal of Urology, Dr. Ian Thompson and associates report that finasteride improves prostate cancer (CaP) detection with digital rectal examination (DRE). The authors hypothesized that finasteride would improve the detection of CaP by shrinking the prostate and resulting in a more sensitive DRE. They performed their study using the Prostate Cancer Prevention Trial database. The seven year study randomized men to finasteride 5mg daily or placebo and follow-up included prostate biopsies in those with increases in PSA or an abnormal DRE.

After exclusions, 4,579 participants in the finasteride arm, including 873 with biopsy for PSA >4.0ng/mlor abnormal DRE and 3,706 without either indication, and 5,112 in the placebo arm, including 1,012 with biopsy for increased PSA or abnormal DRE and 4,100 without either indication, were available for analysis. Indications for biopsy were usually either an elevated PSA or abnormal DRE, but rarely both. Increased PSA led to diagnosis of CaP in 33% of men on finasteride and 24% on placebo. In the 15.2% in the finasteride arm with the diagnosis of CaP, tumor grade was available in 686; Gleason 7 or higher occurred in 264 and Gleason 8 or higher in 81 men. In the 21.7% in the placebo arm diagnosed with CaP, tumor grade was available in 1,111; Gleason 7 or higher occurred in 240 and Gleason 8 or higher in 55 men.

DRE sensitivity was significantly higher for detecting CaP in men on finasteride compared to placebo (21.3% vs. 16.7%). A trend for increased DRE detection in high grade disease for those on finasteride existed as well, although it did not reach statistical significance. DRE specificity exceeded 90% in the two groups and was not different between the groups. DRE performed better for high-grade disease than for cancer overall in each group. Regardless of PSA level, DRE sensitivity for CaP detection was better in men on finasteride.

Thompson IM, Tangen CM, Goodman PJ, Lucia MS, Parnes HL, Lippman SM, Coltman Jr. CA

J Urol 2007; 177(5): 1749-52
Reviewed by UroToday Contributing Editor Christopher P. Evans, MD

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