Low reduction of prostate volume is a significant predictor of prostate cancer at subsequent biopsy in patients with dutasteride: A retrospective study

Abstract

Appropriate decision of prostate biopsy in men with 5α‐reductase inhibitor (5AR inhibitor) is still unclear to avoid unnecessary biopsy. We retrospectively investigated patients with initial PSA 4.0 ng/ml or more and underwent subsequent prostate biopsy following dutasteride treatment. From September 2009 to August 2018, 399 cases of benign prostate hyperplasia (BPH) were treated with dutasteride in our department. Of the total, 36 cases with elevated pre‐treatment PSA (4.0 ng/ml or more) and underwent subsequent prostate biopsy were included into this study. We evaluated PSA kinetics and changing prostate volumes (PV), and detection of prostate cancer. Overall, average PSA reduced by half at 6 months from dosing. Pre‐treatment biopsy was performed in 17 of 36 cases, and all were diagnosed as having no malignancy. After treatment, prostate cancer was detected in 15 cases by subsequent biopsy. Fourteen of 15 cases were clinically significant cancer (Gleason score 7 or more). Logistic regression analysis detected a nominal association between prostate cancer detection and three variants, PSAD, PV reduction (1–Before/After PV) and abnormal MRI findings. In addition to abnormal MRI findings and pre‐treatment of high PSAD, the case with low reduction of PV after treatment should consider performing prostate biopsy.

Characteristics of prostate biopsy in patients under the dutasteride treatment

“…In addition to previous studies that reported that PSA density, prostate volume reduction rate, and MRI findings are important predictive factors for PCa detection, [11] we found that advanced age and abnormal MRI findings were clinically significant predictors of high grade PCa in BPH patients treated with dutasteride. The relationship between prostate cancer grade and age is controversial [15] ; however, in this study, age was found to be associated with high-grade prostate cancer in patients treated with dutasteride.…”

“…[11] However, our previous study was based on a small number of patients and did not evaluate comparative studies with patients not treated with dutasteride. [11] Also, the evaluation of biopsy core positivity rates was unknown in our previous study. [11] In this study, we have retrospectively compared the characteristics of prostate biopsies in BPH patients treated with dutasteride and in untreated patients, adjusted for PSA levels and age.…”

“…Previously, we reported that high PSA density, low prostate volume reduction, and positive abnormal magnetic resonance imaging (MRI) findings are significant predictive factors for Pca in BPH patients treated with dutasteride. [11] However, our previous study was based on a small number of patients and did not evaluate comparative studies with patients not treated with dutasteride. [11] Also, the evaluation of biopsy core positivity rates was unknown in our previous study.…”

“…[11] Also, the evaluation of biopsy core positivity rates was unknown in our previous study. [11] In this study, we have retrospectively compared the characteristics of prostate biopsies in BPH patients treated with dutasteride and in untreated patients, adjusted for PSA levels and age.…”