Mp31-04 How Do 5-Alpha-Reductase Inhibitors Change Psa Density in Patients on Active Surveillance?

You have accessJournal of UrologyProstate Cancer: Detection & Screening III (MP31)1 May 2024MP31-04 HOW DO 5-ALPHA-REDUCTASE INHIBITORS CHANGE PSA DENSITY IN PATIENTS ON ACTIVE SURVEILLANCE? Lindsey T. Webb, Gabriela M. Diaz, Syed N. Rahman, Ghazal Khajir, and Preston C. Sprenkle Lindsey T. WebbLindsey T. Webb , Gabriela M. DiazGabriela M. Diaz , Syed N. RahmanSyed N. Rahman , Ghazal KhajirGhazal Khajir , and Preston C. SprenklePreston C. Sprenkle View All Author Informationhttps://doi.org/10.1097/01.JU.0001008936.35187.0b.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Since 5-alpha-reductase inhibitors (5ARIs) decrease both prostate size and PSA, the purpose of this study was to determine how 5ARIs affect PSA Density (PSAD) in patients who progress to GG2+ disease or treatment compared to those who do not progress. METHODS: An IRB-approved prospectively collected database of patients having undergone MRI-US fusion prostate biopsy was queried to identify those on active surveillance (AS). Patients' charts were reviewed to determine if a patient had taken finasteride (5 mg) or dutasteride (0.5 mg) and the period when the 5ARI was taken. Chi squared was used to compare number of patients and Mann-Whitney U was used to compare PSAD in patients who progressed to GG2+ disease or treatment to those who did not. RESULTS: A total of 445 patients from our institutional database were identified as on active surveillance with at least 2 prostate biopsies. Of these, 47 patients had taken a 5ARI. The median (mdn) PSAD of patients before starting, while taking, and after stopping a 5ARI was 0.106, 0.109, and 0.079, respectively. When looking at progression to GG2+ disease or progression to treatment, in both cases, 4 men progressed before, 11 during, and 3 after taking a 5ARI. Over the first two years of AS for patients on 5ARIs, 26%/year and 23%/year progressed to GG2+ and treatment, respectively. Over the first two years for patients not on 5ARIs, 31%/year (p=0.41) and 19%/year (p=0.48) progressed to GG2+ and treatment, respectively. The PSADs of the patients on a 5ARI who progressed to GG2+ (mdn 0.139) were significantly higher than the PSADs of the patients who did not progress to GG2+ (mdn 0.074; p=.013. Also, patients on 5ARI who progressed to treatment had higher PSADs than those who remained on AS (mdn 0.190 vs 0.074; p=.006). CONCLUSIONS: Even though 5ARIs decrease the PSAD of patients on AS, patients on 5ARIs still have elevated PSADs when they progress to GG2+ or treatment, and 5ARIs may more starkly differentiate those patients with clinically significant disease. More data is needed to determine clinical PSAD cutoffs for biopsy for patients on 5ARIs. Download PPTDownload PPT Source of Funding: Yale Department of Urology © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e504 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Lindsey T. Webb More articles by this author Gabriela M. Diaz More articles by this author Syed N. Rahman More articles by this author Ghazal Khajir More articles by this author Preston C. Sprenkle More articles by this author Expand All Advertisement PDF downloadLoading ...