Battling Prostate Cancer with 5-Alpha-Reductase Inhibitors: a Pyrrhic Victory?
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Given the relatively small impact of prostate cancer screening on cancer mortality, experts are now suggesting that chemoprevention with 5-alpha-reductase inhibitors (5-ARI) may be a more effective strategy for cancer control. Two large placebo-controlled randomized trials found that men receiving 5-ARI were about 25% less likely than controls to be detected with cancer. However, most cancers were detected on routine biopsies required by study protocols. The benefit from receiving 5-ARI was minimal among men who underwent biopsy for clinical indications. Additionally, men receiving 5-ARI were more likely than controls to be diagnosed with high-grade cancers, though post-hoc analyses adjusting for biases accounted for the excess risk in one of the studies. A recent guideline recommended that men considering prostate cancer screening also consider chemoprevention. The rationale is that reducing cancer incidence, given the known risks for overdiagnosis and subsequent overtreatment, is sufficient justification for chemoprevention. However, a large randomized controlled trial found that screening was associated with a 70% increase in prostate cancer diagnosis—which chemoprevention would then reduce by 25%. This does not seem an acceptable trade-off especially because the potential increased risk for high-grade cancers could lead to higher cancer mortality.
- Andriole GL, Crawford ED, Grubb RL 3rd, et al. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360:1310–9. CrossRef
- Schroder FH, Hugosson J, Roobol MJ, et al. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360:1320–8. CrossRef
- Etzioni R, Tsodikov A, Mariotto A, et al. Quantifying the role of PSA screening in the US prostate cancer mortality decline. Cancer Causes Control. 2008;19:175–81. CrossRef
- Altekruse SF, Kosary C, Krapcho M, et al. SEER Cancer Statistics Review 1975-2007. Bethesda, MD: National Cancer Institute; 2010. Available at: http://seer.cancer.gov/csr/1975_2007/. Accessed December 8, 2010.
- Kolota G. Cancer society, in shift, has concerns on screenings. New York Times. October 20, 2009.
- Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. Jama. 2009;302:1685–92. CrossRef
- Kramer BS, Hagerty KL, Justman S, et al. Use of 5-alpha-reductase inhibitors for prostate cancer chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline. J Clin Oncol. 2009;27:1502–16. CrossRef
- Imperato-McGinley J, Zhu YS. Androgens and male physiology the syndrome of 5alpha-reductase-2 deficiency. Mol Cell Endocrinol. 2002;198:51–9. CrossRef
- Thompson IM, Goodman PJ, Tangen CM, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003;349:215–24. CrossRef
- Andriole GL, Bostwick DG, Brawley OW, et al. Effect of dutasteride on the risk of prostate cancer. N Engl J Med. 2010;362:1192–202. CrossRef
- Lucia MS, Darke AK, Goodman PJ, et al. Pathologic characteristics of cancers detected in The Prostate Cancer Prevention Trial: implications for prostate cancer detection and chemoprevention. Cancer Prev Res (Phila Pa). 2008;1(3):167–73. CrossRef
- Pinsky P, Parnes H, Ford L. Estimating rates of true high-grade disease in the prostate cancer prevention trial. Cancer Prev Res (Phila Pa). 2008;1:182–6. CrossRef
- Redman MW, Tangen CM, Goodman PJ, Lucia MS, Coltman CA Jr, Thompson IM. Finasteride does not increase the risk of high-grade prostate cancer: a bias-adjusted modeling approach. Cancer Prev Res (Phila Pa). 2008;1:174–81. CrossRef
- Draisma G, Etzioni R, Tsodikov A, et al. Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context. J Natl Cancer Inst. 2009;101:374–83. CrossRef
- Narod SA. Compliance with tamoxifen in women with breast cancer and a BRCA1 or BRCA2 mutation. J Clin Oncol. 2010;28:e698–e9. CrossRef
- Walsh PC. Chemoprevention of prostate cancer. N Engl J Med. 2010;362:1237–8. CrossRef
- Thompson IM, Tangen CM, Goodman PJ, Lucia MS, Klein EA. Chemoprevention of prostate cancer. J Urol. 2009;182:499–507. CrossRef
- Hamilton RJ, Kahwati LC, Kinsinger LS. Knowledge and Use of Finasteride for the Prevention of Prostate Cancer. Cancer Epidemiol Biomarkers Prev. 2010;19:2164–71. CrossRef
- Kolota G. F.D.A. Panel rejects expanded use of prostate drug. New York Times. December 1, 2010.
- Battling Prostate Cancer with 5-Alpha-Reductase Inhibitors: a Pyrrhic Victory?
Journal of General Internal Medicine
Volume 26, Issue 7 , pp 798-801
- Cover Date
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- prostatic neoplasms
- evidence-based practice
- Industry Sectors
- Author Affiliations
- 1. Medicine Service, New Mexico VA Health Care System, 1501 San Pedro Drive SE, Mailstop 111, Albuquerque, NM, 87108, USA
- 2. Department of Medicine, University of New Mexico School of Medicine, Albuquerque, USA
- 3. Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA
- 4. Foundation for Informed Medical Decision Making, Boston, USA
- 5. Department of Medicine, Harvard Medical School, Boston, USA