5ARIs have been shown to prevent prostate cancer in two large randomized controlled trials. However, there are no studies evaluating use of 5ARIs on those already diagnosed with low risk prostate cancer. This study determined the effect of 5ARIs on pathologic progression in men on active surveillance for prostate cancer. It was a single institution retrospective cohort study comparing men taking a 5ARI versus no 5ARI while on active surveillance for prostate cancer. All men had at least two biopsies and met very low-risk inclusion criteria for active surveillance. Pathologic progression was evaluated and defined as Gleason score >6, or maximum core involvement >50% or >3 cores positive on a follow-up prostate biopsy. Univariate, multivariate and Kaplan-Meir analyses were conducted.
A total of 288 men on active surveillance were studied. The median follow-up was 38.5 months with 93 men (32%) experiencing pathologic progression and 96 men (33%) abandoning active surveillance. Men taking a 5ARI experienced a lower rate of pathologic progression (18.6% vs. 36.7%, p=0.004) and were less likely to abandon active surveillance (20% vs. 37.6%, p=0.006). The median time to progression was longer in the 5ARI group (42.5 months) compared to the non-5ARI group (31.5 months; p=0.026). On multivariate analysis, lack of 5ARI use was most strongly associated with pathologic progression (OR 2.98) followed by age and baseline maximum percentage involvement of any biopsy core.
Presented by Antonio Finelli, et al. at the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Christopher P. Evans, MD, FACS, Professor and Chairman, Department of Urology, University of California, Davis, School of Medicine.