The new insight of prostate-specific antigen reduction during finasteride therapy in aging men

Abstract

Objective

To evaluate the effect of finasteride on prostate-specific antigen (PSA) in Chinese population.

Materials and methods

From Feb 2011 to Jan 2012, 83 benign prostatic hyperplasia (BPH) patients with prostate volume (PV) >30 mL were enrolled in our study. All the patients were older than 50 years and all of them received combined therapy (finasteride + doxazosin). All the patients were required for 1-year follow-up. PSA level and PV was measured at the start, 6 and 12 months, respectively.

Results

79 patients completed the follow up. PSA level reduced by approximately 40 % during finasteride therapy. We defined baseline PSA as PSA1, PSA at 6 months as PSA2, PSA at 12 months as PSA3. PSA1 was significantly correlated with PSA2/PSA1 and PSA3/PSA1. However, prostate volume was not correlated with PSA1. We divided the patients into three groups according to PSA level. Groups 1, 2, 3 represented the patients with PSA less than 2 ng/mL, between 2 and 4 ng/mL and greater than 4 ng/mL, respectively. Both the PSA2/PSA1 and the PSA3/PSA1 had significant difference among three groups. Furthermore, group 1 and group 2 both showed the fairly large data variance.

Conclusions

When baseline PSA level was greater than 4 ng/mL, the doubling rule could be used for screening. When baseline PSA level was less than 4 ng/Ml, the doubling rule might not be an accurate predictor. We can use the PSA rise from nadir or proPSA to predict prostate cancer.

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References

  1. 1.

    Berry SJ, Coffey DS, Walsh PC et al (1984) The development of human benign prostatic hyperplasia with age. J Urol 132:474–479

    CAS  PubMed  Google Scholar 

  2. 2.

    DiSantostefano RL, Biddle AK, Lavelle JP (2006) The long-term cost effectiveness of treatments for benign prostatic hyperplasia. Pharmacoeconomics 24:171–191

    Article  PubMed  Google Scholar 

  3. 3.

    Jacobsen SJ, Jacobson DJ, Girman CJ et al (1997) Natural history of prostatism: risk factors for acute urinary retention. J Urol 158:481–487

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Guess HA (1992) Benign prostatic hyperplasia: antecedents and natural history. Epidemiol Rev 14:131–153

    CAS  PubMed  Google Scholar 

  5. 5.

    Barry MJ, Fowler FJ Jr, Bin L et al (1997) The natural history of patients with benign prostatic hyperplasia as diagnosed by North American urologists. J Urol 157:10–14

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Holtgrewe HL (1998) Current trends in management of men with lower urinary tract symptoms and benign prostatic hyperplasia. Urology Suppl 51:1

    Article  Google Scholar 

  7. 7.

    Gormley GJ (1992) Chemoprevention strategies for prostate cancer: the role of 5 alpha-reductase inhibitors. J Cell Biochem Suppl 16H:113

    Article  Google Scholar 

  8. 8.

    Rasmusson GH, Reynolds GF, Steinberg NG et al (1986) Structure–activity relationships for inhibition of 5-alpha reductase and of androgen receptor binding. J Med Chem 29:2298–2315

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    McConnell JD, Bruskewitz R, Walsh PC et al (1998) The effect of finasteride on the risk of acute urinary retention and the need for surgical treatment among men with benign prostatic hyperplasia. Finasteride Long-Term Efficacy and Safety Study Group. N Engl J Med 338:557–563

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Marks Leonard S, Andriole Gerald L, John M et al (2006) The interpretation of serum prostate specific antigen in men receiving 5-reductase inhibitors: a review and clinical recommendations. J Urol 176:868–874

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Sarma AV, Schottenfeld D (2002) Prostate cancer incidence, mortality, and survival trends in the United States: 1981–2001. Semin Urol Oncol 20:3

    Article  PubMed  Google Scholar 

  12. 12.

    Stephan C, Jung K, Lein M et al (2007) PSA and other tissue kallikreins for prostate cancer detection. Eur J Cancer 43:1918–1926

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Guess HA, Gormley GJ, Stoner E et al (1996) The effect of finasteride on prostate specific antigen: review of available data. J Urol 155:3–9

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Gormley GJ, Ng J, Cook T et al (1994) Effect of finasteride on prostate-specific antigen density. Urology 43:53–58

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Pannek Jurgen, Marks Leonard S, Peason Jay D et al (1998) Influence of finasteride on free and total serum prostate special antigen levels in men with benign prostatic hyperplasia. J Urol 159:449–453

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Choi YH, Cho SY, Cho IR (2010) The different reduction rate of prostate-specific antigen in dutasteride and finasteride. Korean J Urol 51:704–708

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    McConnell JD, Roehrborn CG, Bautista OM et al (2003) The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med 349:2387–2398

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Gormley GJ, Stoner E, Bruskewitz RC et al (1992) The effect of finasteride in men with benign prostatic hyperplasia. The finasteride study group. New Engl J Med 327:1185

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    The Finasteride Study Group (1993) Finasteride (MK-906) in the treatment of benign prostatic hyperplasia. Prostate 22:291

    Article  Google Scholar 

  20. 20.

    Guess HA, Heyse JF, Gormley GJ (1993) The effect of finasteride on prostate-specific antigen in men with benign prostatic hyperplasia. Prostate 22:31

    CAS  Article  PubMed  Google Scholar 

  21. 21.

    Montironi R, Valli M, Fabris G (1996) Treatment of benign prostatic hyperplasia with 5α-reductase inhibitor: morphological changes in patients who fail to respond. J Clin Path 49:324

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Marks LS, Partin AW, Gormley GJ et al (1997) Prostate tissue composition and response to finasteride in men with symptomatic benign prostatic hyperplasia. J Urol 157:2171

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Vidigal DJ, Silva AL, Vasconcelos AC et al (2010) Effect of finasteride on serum prostate-specific antigen (PSA) and on prostate of hamster Mesocricetus auratus (hMa). Acta Cir Bras 25:47–54

    Article  PubMed  Google Scholar 

  24. 24.

    Makridakis NM, di Salle E, Reichardt JK (2000) Biochemical and pharmacogenetic dissection of human steroid 5α-reductase type II. Pharmacogenetics 10:407

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Gu X, Na R, Huang T et al (2013) SRD5A1 and SRD5A2 are associated with treatment for benign prostatic hyperplasia with the combination of 5α-reductase inhibitors and α-adrenergic receptor antagonists. J Urol 190:615–619

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Reichardt JK, Makridakis N, Henderson BE et al (1995) Genetic variability of the human SRD5A2 gene: implications for prostate cancer risk. Cancer Res 55:3973

    CAS  PubMed  Google Scholar 

  27. 27.

    Zeigler-Johnson CM, Walker AH, Mancke B et al (2002) Ethnic differences in the frequency of prostate cancer susceptibility alleles at SRD5A2 and CYP3A4. Hum Hered 54:13–21

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Li Jun, Coates Ralph J, Gwinn Marta et al (2010) Steroid 5-α-reductase type 2 (SRD5A2) gene polymorphisms and risk of prostate cancer: a HuGE review. Am J Epidemiol 171:1–13

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank all patients for their ongoing participation in this study. The authors also wish to thank Wen-bin Guan for his contribution of specimen procession and evaluation to this article.

Funding

This study was funded by a grant from Science and Technology Commission of Shanghai Municipality (CN) (No. 134119a0600 and 14430720800).

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Correspondence to Jun Qi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethics Committee of Xinhua Hospital Affiliated to Shanghai University School of Medicine and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

D. Xu and J. Ding contributed equally to this article.

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Xu, D., Ding, J., Zhu, Y. et al. The new insight of prostate-specific antigen reduction during finasteride therapy in aging men. Aging Clin Exp Res 28, 1237–1241 (2016). https://doi.org/10.1007/s40520-015-0512-3

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Keywords

  • Benign prostatic hyperplasia
  • Prostate-specific antigen
  • Finasteride