[The Prostate Cancer Prevention Trial (PCPT). Relevance for clinical practice].
The Prostate Cancer Prevention Trial (PCPT) has been the first interventional trial directly aimed at the prevention of prostate cancer. A total of 18,882 men over 55 years with a PSA serum level less than 3.0 ng/ml were randomized to receive either the 5-alpha-reductase inhibitor finasteride 5 mg/day or placebo for 7 years. Despite a 25% reduction of prostate cancers in the treatment arm the results were discussed controversially. This criticism was mainly due to the observation of significantly more high-grade cancers in the finasteride group. Meanwhile, results of extensive follow-up analyses have been published suggesting that this finding is most likely due to optimized tumor detection in smaller glands. Further work-up demonstrated that PSA diagnosis and the histopathological examination were not compromised by finasteride. Furthermore, in addition to a decrease of prostate cancer the amount of prostatic intraepithelial dysplasia (PIN) was also reduced under finasteride. Future research must now aim at defining high-risk groups specifically profiting from chemoprevention with a 5-alpha-reductase inhibitor.
Schmitz-Dräger
B J
BJ
Urologie, EuromedClinic, Europa-Allee 1, 90763 Fürth. bsd@euromed.de
Fischer
C
C
Bismarck
E
E
Dörsam
H J
HJ
Lümmen
G
G
D058891:5-alpha Reductase Inhibitors; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D004791:Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018120:Finasteride / Q000009:adverse effects / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011467:Prostate / Q000473:pathology; D017430:Prostate-Specific Antigen / Q000097:blood; D019048:Prostatic Intraepithelial Neoplasia / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D011471:Prostatic Neoplasms / Q000139:chemically induced / Q000473:pathology / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
D058891:5-alpha Reductase Inhibitors; D014408:Biomarkers, Tumor; D004791:Enzyme Inhibitors; D018120:Finasteride; D017430:Prostate-Specific Antigen