5-alpha reductase inhibitor slows progression of low-risk prostate cancer tumors

Active surveillance added to treatment with the 5-alpha reductase inhibitor dutasteride slowed the progression of cancerous prostate tumors in men with low-risk localized disease, according to researchers from the University of Toronto in Ontario, Canada.

Key Point: Active surveillance in combination with dutasteride is a reasonable strategy for the treatment of low-risk prostate cancer.

The World Health Organization’s International Agency for Research on Cancer estimated in its GLOBOCAN 2008 global report on cancer prevalence that about 14,000 cases of prostate cancer are diagnosed in India each year. As India continues to develop economically, it’s possible that this number could increase, because the rate of diagnosed prostate cancer cases is approximately 2 to 5 times higher in[s2If !is_user_logged_in()]…

[/s2If][s2If is_user_logged_in()] developed countries, according to the report. It’s unclear whether the difference in these rates is due to diagnostic practices, a complex constellation of risk factors, and/or a combination.

In the Canadian study of 302 men (median age: 65 years) who had low-risk prostate cancer defined as stage T1c-T2a and a Gleason score6, ≥4 cores positive, or >50% of any core positive) or therapeutic progression (receipt of radical prostatectomy, radiation therapy, or hormonal ablation).

At 3 years, 48% of the men in the control group had progression of their disease compared with 38% of men randomized to dutasteride, corresponding to a relative risk reduction of 38%. At the final biopsy, 36% of the men in the dutasteride group were free of cancer on biopsy compared with only 23% of the controls.

Among the men who had a Gleason score >6 at the final biopsy (19 in the dutasteride group and 22 in the control group), tumor length was shorter and the percentage of positive cores was lower in the men assigned to dutasteride vs. placebo.

Anxiety as measured by the memorial anxiety scale for prostate cancer was significantly lower in the men randomized to dutasteride vs. placebo. The authors write that the reduction in anxiety seemed to be driven by a reduced fear of prostate cancer recurrence.

The incidence of drug-related adverse vents was similar between the 2 groups.

Source: Fleshner NE, Lucia MS, Egerdie B, et al. Dutasteride in localised prostate cancer management: the REDEEM randomised, double-blind, placebo-controlled trial. Lancet 2012;January 23 [Epub ahead of print].

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