The effect of 5-reductase inhibitor on clinicopathologic characteristics of prostate cancer in patient who undergo radical prostatectomy

INTRODUCTION AND OBJECTIVES: Clinical studies provide significant evidence supporting the use of 5a-reductase inhibitors (5-ARIs) to reduce the overall detection rate of prostate cancer (PCa). Two large randomized controlled trials have shown a reduction in the detection of low grade PCa with the use of 5-ARIs. However, the medication was also found to be associated with an absolute increase in high-grade PCa. This study explored a possible association between the use of the 5ARIs and clinicopathologic characteristics including tumor volume (TV) of PCa in patients who undergo radical prostatectomy (RP). METHODS: We reviewed the medical records, 12-core transrectal sono-guided prostatic biopsy specimens and TV by visual estimation (percentage of the prostate involved by tumor) of 1781 patients who underwent prostatic biopsy and RP for PCa between 2007 and 2012. The pathologic reports of the prostatic biopsy specimens and RP specimens were carried out by same pathologist. The RP specimens were sectioned in the fresh state from the apex to the base at approximately 3-mm intervals perpendicular to the urethra. A visual inspection of the slides with highlighted cancer was then done, and an estimate of the average percentage of cross-sectional area involved by cancer was established. RESULTS: Of 1924 patients, 133 reported having history of taking 5-ARIs for the treatment of BPH. Comparing the 5-ARI users and nonusers, 5-ARIs users were older (67.8¡3/45.5 Vs. 65.8¡3/46.9, P<0.005) and preoperative PSA were lower (6.9¡3/46.4ng/ml Vs. 11.0¡3/429.8ng/ml, P<0.001). No significant differences were observed between the two groups in prostate volume, clinical stage, biopsy Gleason score and resection margin status (all P > 0.05). 5-ARI users were found to have lower T stage (p<0.040), lower pathologic Gleason score (p<0.010), lower positive biopsy core (2.4¡3/41.6 Vs. 2.9¡3/42.8, p<0.039) and lower TV (11.1¡3/414.8% Vs. 16.7¡3/418.2%, p<0.001) compared with nonusers. When adjusted for preoperative factors including age, PSA2 (preoperative PSA value X2 in 5-ARIs users), clinical stage, biopsy Gleason score, and prostate volume, history of 5-ARI treatment was still revealed to be significantly associated with low TV (¥â<-8.975, 95%CI -10.512<-7.438, p<0.001). CONCLUSIONS: 5ARIs treatment was associated with the lower positive biopsy core and TV of PCa but also related with lower T stage and lower pathologic Gleason score.The relationship between 5ARIs and TV of PCa and the clinical implication needs further examination.