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. 2008 May;71(5):854-7.
doi: 10.1016/j.urology.2008.01.025.

Does the level of prostate cancer risk affect cancer prevention with finasteride?

Ian M Thompson  1 , Catherine M Tangen, Howard L Parnes, Scott M Lippman, Charles A Coltman Jr
Affiliations

Does the level of prostate cancer risk affect cancer prevention with finasteride?

Ian M Thompson et al. Urology. 2008 May.

Abstract

Objectives: Finasteride reduced the risk of prostate cancer by 24.8% in the Prostate Cancer Prevention Trial (PCPT). Whether this represents treatment or prevention and who is most likely to benefit are unknown. We sought to clarify these issues by this investigation.

Methods: We fit a logistic regression model to men in the placebo group of the PCPT using risk factors for prostate cancer at entry to predict prostate cancer during the subsequent 7 years of study. Men in the two treatment groups were categorized into quintiles of risk of prostate cancer based on the predictive logistic model. A second model was fit evaluating finasteride's effect on prostate cancer for each subgroup defined by quartiles of baseline prostate-specific antigen (PSA) . The magnitude of the prevention effect of finasteride on prostate cancer was then evaluated across risk and PSA strata.

Results: Finasteride significantly reduced prostate cancer risk for all risk quintiles. For quintiles 1 through 5, odds ratios were 0.72, 0.52, 0.64, 0.66, and 0.71, respectively (all P < or = 0.05). For quartiles of risk of entry PSA (less than 0.7 ng/mL, 0.7 to 1.1 ng/mL, 1.1 to 1.7 ng/mL, and 1.8 to 3.0 ng/mL), odds ratios increased (smaller treatment effect) as PSA increased: 0.60, 0.62, 0.66, and 0.69, respectively, but remained significant for all strata (each P < 0.001).

Conclusions: Finasteride significantly reduced prostate cancer risk regardless of the level of this risk, estimated either by multivariable risk or by PSA stratum; this suggests that finasteride exerts both treatment and preventive effects. All men undergoing PSA screening should be informed of the potential for finasteride to reduce their risk of prostate cancer.

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Figures

Figure 1
Figure 1
Estimated odds ratio of prostate cancer for finasteride vs. placebo group, stratified by quintile of prostate cancer risk
Figure 2
Figure 2
Hypothetical figure for two effects of finasteride: prevention or treatment.
See this image and copyright information in PMC

References

    1. Thompson IM, Goodman PJ, Tangen CM, Lucia MS, Miller GJ, Ford LG, Lieber MM, Cespedes RD, Atkins JN, Lippman SM, Carlin SM, Ryan A, Szczepanek CM, Crowley JJ, Coltman CA., Jr The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003;349:215–24. - PubMed
    1. Thompson IM, Chi C, Ankerst DP, Goodman PJ, Tangen CM, Lippman SM, Lucia MS, Parnes HL, Coltman CA., Jr Effect of finasteride on the sensitivity of PSA for detecting prostate cancer. J Natl Cancer Inst. 2006;98:1128–33. - PubMed
    1. Thompson IM, Tangen CM, Goodman PJ, Lucia MS, Parnes HL, Lippman SM, Coltman CA., Jr Finasteride improves the sensitivity of digital rectal examination for prostate cancer detection. J Urology. 2007;177:1749–52. - PubMed
    1. Lucia MS, Epstein JI, Goodman PJ, Darke AK, Reuter VE, Civantos F, Tangen CM, Parnes HL, Lippman SM, LaRosa FG, Kattan MW, Crawford ED, Ford LG, Coltman CA, Thompson IM. Finasteride and high-grade prostate cancer in the PCPT. Journal of the National Cancer Institute. 2007;99:1375–83. - PubMed
    1. Thompson IM, Pauler DK, Goodman PJ, Tangen CM, Lucia MS, Parnes HL, Minasian LM, Ford LG, Lippman SM, Crawford ED, Crowley JJ, Coltman CA., Jr Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. N Engl J Med. 2004;350:2239–46. - PubMed