Prediction of prostate cancer for patients receiving finasteride: results from the Prostate Cancer Prevention Trial.
OBJECTIVE
Using data from men in the finasteride group of the Prostate Cancer Prevention Trial (PCPT), we evaluated the impact of prostate-specific antigen (PSA) and other risk factors on the risk of prostate cancer.


METHODS
Four thousand four hundred forty men in the finasteride group of the PCPT underwent prostate biopsy, had at least one PSA and a digital rectal exam (DRE) during the year before biopsy, had at least two PSA values from the 3 years before biopsy, and were on finasteride at the time of PSA evaluation. Logistic regression was conducted using the variables age, race, family history of prostate cancer, PSA, PSA velocity, and DRE adjusting for history of prior prostate biopsy.


RESULTS
Six hundred forty-nine (14.6%) of 4,440 men were diagnosed with prostate cancer; 250 had Gleason 7 or higher cancer. Factors associated with an increased risk of prostate cancer included high PSA value and a rising PSA (24.9% risk for PSA value of 1.0 ng/mL and 24.8% risk for a rising PSA), family history of prostate cancer, abnormal DRE result, African American race, and older age. Factors associated with an increased risk of Gleason 7 or higher grade prostate cancer included PSA, abnormal DRE, and older age. A prior negative biopsy was associated with decreased risk of prostate cancer and high-grade prostate cancer.


CONCLUSIONS
Risk factors for prostate cancer on biopsy for men receiving finasteride include PSA, DRE, age, race, family history, and history of a prior negative biopsy. With the exception of the approximate reduction of PSA by half with finasteride, the impact of these risk factors is similar to men who do not receive finasteride.
Thompson
Ian M
IM
Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA. thompsoni@uthscsa.edu
Pauler Ankerst
Donna
D
Chi
Chen
C
Goodman
Phyllis J
PJ
Tangen
Catherine M
CM
Lippman
Scott M
SM
Lucia
M Scott
MS
Parnes
Howard L
HL
Coltman
Charles A
CA
D000284:Administration, Oral; D000368:Aged; D001707:Biopsy, Needle; D016001:Confidence Intervals; D051517:Digital Rectal Examination; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D018120:Finasteride / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011315:Preventive Medicine / Q000379:methods; D011336:Probability; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology*; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
D018120:Finasteride; D017430:Prostate-Specific Antigen