Der Urologe

, Volume 46, Issue 10, pp 1364–1370

Das „Prostate Cancer Prevention Trial“ (PCPT)

Die Bedeutung für den klinischen Alltag
  • B.J. Schmitz-Dräger
  • C. Fischer
  • E. Bismarck
  • H.J. Dörsam
  • G. Lümmen
Leitthema

Zusammenfassung

Das „Prostate Cancer Prevention Trial“ (PCPT) ist die erste große Interventionsstudie, die gezielt auf die Prävention eines Prostatakarzinoms ausgerichtet war. Insgesamt wurden 18.882 Männer >55 Jahre mit einem PSA-Wert von <3,0 ng/ml in einen Kontroll- und einen Behandlungsarm (Finasterid 5 mg/Tag für 7 Jahre) randomisiert. Trotz einer Reduktion des Nachweises von Prostatakarzinomen um rund 25% wurden die Ergebnisse überaus kontrovers diskutiert. Dies war auf den vermehrten Nachweis von aggressiven Prostatakarzinomen zurückzuführen. Inzwischen liegen die Ergebnisse von umfangreichen Nachuntersuchungen vor, die darauf hinweisen, dass dieser Effekt wahrscheinlich auf einem optimierten Tumornachweis in der durch Finasterid verkleinerten Prostata beruht. Weitere Ergebnisse der Aufarbeitung von PCPT zeigen, dass die Einnahme von Finasterid die Diagnostik und den histopathologischen Nachweis von Prostatakarzinomen nicht beeinträchtigt. Neben einer Reduktion von Prostatakarzinomen fand sich auch eine Verminderung von Präneoplasien (PIN) unter Finasterid. Ziel künftiger Bemühungen muss es nun sein, Risikogruppen zu definieren, die von einer Chemoprävention mit einem 5α-Reduktasehemmer in besonderer Weise profitieren.

Schlüsselwörter

Chemoprävention Prostatakarzinom Finasterid 

The Prostate Cancer Prevention Trial (PCPT)

Relevance for clinical practice

Abstract

The Prostate Cancer Prevention Trial (PCPT) has been the first interventional trial directly aimed at the prevention of prostate cancer. A total of 18,882 men over 55 years with a PSA serum level less than 3.0 ng/ml were randomized to receive either the 5-α-reductase inhibitor finasteride 5 mg/day or placebo for 7 years. Despite a 25% reduction of prostate cancers in the treatment arm the results were discussed controversially. This criticism was mainly due to the observation of significantly more high-grade cancers in the finasteride group. Meanwhile, results of extensive follow-up analyses have been published suggesting that this finding is most likely due to optimized tumor detection in smaller glands. Further work-up demonstrated that PSA diagnosis and the histopathological examination were not compromised by finasteride. Furthermore, in addition to a decrease of prostate cancer the amount of prostatic intraepithelial dysplasia (PIN) was also reduced under finasteride. Future research must now aim at defining high-risk groups specifically profiting from chemoprevention with a 5-α-reductase inhibitor.

Keywords

Chemoprevention Prostate cancer Finasteride 

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Copyright information

© Springer Medizin Verlag 2007

Authors and Affiliations

  • B.J. Schmitz-Dräger
    • 1
  • C. Fischer
    • 2
  • E. Bismarck
    • 1
  • H.J. Dörsam
    • 1
  • G. Lümmen
    • 3
  1. 1.UrologieEuromedClinicFürthDeutschland
  2. 2.Urologische KlinikKrankenhaus Hohe Warthe, KlinikumBayreuthDeutschland
  3. 3.Urologische KlinikSt. Josef HospitalTroisdorfDeutschland

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