title: Active surveillance of very-low-risk prostate cancer in the setting of active treatment of benign prostatic hyperplasia with 5α-reductase inhibitors.
abstract: OBJECTIVE
  To review the efficacy of treating benign prostatic hyperplasia and very-low-risk prostate cancer (PCa) in patients receiving active surveillance and 5α-reductase inhibitor (5-ARI; finasteride or dutasteride) treatment.
  
  
  METHODS
  Eighty-two men with very-low-risk PCa (clinical stage T1c, Gleason score ≤ 6, <3 biopsy cores positive with ≤ 50% involvement, and prostate-specific antigen density ≤ 0.15 ng/mL/g) and benign prostatic hyperplasia (≥ 30 cm(3)) received active surveillance and were treated with a 5-ARI.
  
  
  RESULTS
  All 82 men completed 1 year of 5-ARI therapy (n = 79) or underwent early biopsy for cause (n = 3). Restaging biopsies were performed for 76 men (22 underwent a second restaging biopsy and 1 a third restaging biopsy), 4 patients were awaiting biopsy, and 2 were lost to follow-up before the first restaging biopsy. At the first restaging biopsy, of the 76 men, 41 (54%) had no PCa, 16 (21%) continued to have very-low-risk PCa, 15 (20%) had progressed to low-risk PCa (>2 cores positive and Gleason score ≤ 6), and 4 (5%) had progressed to intermediate-risk PCa (Gleason score 7). Of the 76 biopsies, 20 were performed early for cause, with 11 (55%) showing PCa progression. Of the 82 patients, 22 (27%) underwent treatment of PCa.
  
  
  CONCLUSIONS
  Active surveillance of very-low-risk PCa in the setting of 5-ARI therapy for benign prostatic hyperplasia appears to be a safe therapeutic option, because most (57 of 82; 70%) patients maintained very-low-risk PCa or had negative follow-up biopsies during a 3-year follow-up period. Complementary to the Prostate Cancer Prevention Trial, our results indicate that 5-ARI therapy increases prostate-specific antigen sensitivity and can aid the clinician in appropriately targeting biopsies.
authors.affiliation: McKay Department of Urology, Carolinas Medical Center, Charlotte, NC 28207, USA.
authors.forename: Peter Q
authors.initials: PQ
authors.lastname: Shelton
authors.forename: Allie N
authors.initials: AN
authors.lastname: Ivanowicz
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Wakeman
authors.forename: Michael G
authors.initials: MG
authors.lastname: Rydberg
authors.forename: James
authors.initials: J
authors.lastname: Norton
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Riggs
authors.forename: Chris M
authors.initials: CM
authors.lastname: Teigland
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use*; D000368:Aged; D001706:Biopsy; D018450:Disease Progression; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009657:North Carolina / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D058891:5-alpha Reductase Inhibitors; D017430:Prostate-Specific Antigen