title: Are men on 5α-reductase inhibitors appropriately referred to urology? A survey of primary care physicians.
abstract: OBJECTIVE
  • To investigate among general practitioners (GPs) their level of awareness and indications for urological consultations in patients treated with 5α-reductase inhibitors (5ARIs).
  
  
  METHODS
  • We conducted a survey of GPs in Quebec. • Questions covered GPs' preferred benign prostatic hyperplasia (BPH) management, knowledge of 5ARIs, their role in prostate cancer prevention, and triggers for urology consultation.
  
  
  RESULTS
  • Of the surveys mailed, 599 were returned (15.7% response rate). • Therapy with 5ARIs was initiated by GPs in 34.3%, with 20% and 12% preferring 5ARIs alone and combined with an α-blocker as first-line therapy for BPH, respectively. • Once on therapy, 74% did not refer to a urologist if the PSA level did not decline after 6-12 months. • Finally, 40.7% would not advocate 5ARI chemoprevention for prostate cancer, regardless of risk reduction. • Findings were not associated with GP gender, experience or geographic location of practice (urban versus rural).
  
  
  CONCLUSIONS
  • There was a preference amongst GP to use α-blockers over 5ARIs for BPH and hesitancy to use them in prostate cancer chemoprevention. • There is a lack of awareness of 5ARI effects on PSA kinetics and a reluctance to refer to a urologist. • Further education in Quebec is needed about 5ARIs to optimize their usage and avoid delaying cancer detection.
authors.affiliation: Department of Surgery (Urology), McGill University, Montreal, Quebec, Canada.
authors.forename: Faysal A
authors.initials: FA
authors.lastname: Yafi
authors.forename: Armen G
authors.initials: AG
authors.lastname: Aprikian
authors.forename: Simon
authors.initials: S
authors.lastname: Tanguay
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use*; D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D058005:General Practitioners; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D011792:Quebec; D012017:Referral and Consultation / Q000706:statistics & numerical data*
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists