HCPLive Network

PSA Testing Plus Drug Therapy May Help Identify Prostate Cancer in Some Patients


Researchers at New York-Presbyterian Hospital/Weill Cornell Medical Center have devised a new approach for detecting risk of aggressive prostate cancer, while avoiding unnecessary biopsies.
 
As reported in a news release from Weill Cornell Medical College, investigators found that administering the 5-alpha-reductase inhibitor drugs finasteride and dutasteride to men who had a PSA score of 4 or higher, who had a normal digital rectal examination, and two or more negative biopsies made it easier to “differentiate prostate cancer from benign prostate disease in patients who are difficult to diagnose,” according to lead investigator Steven Kaplan, MD, E. Darracott Vaughan Jr., Professor of Urology at Weill Cornell Medical College and director of the Iris Cantor Men's Health Center at NewYork-Presbyterian/Weill Cornell.
 
The study results were published in The Journal of Urology. For the study, a total of 276 men were given 5 mg finasteride or 0.5 mg dutasteride. In phase I of the study, 97 patients “had their PSA measured at 6 and 12 months, a transrectal ultrasonography and a biopsy performed at 1 year,” according to the Weill Cornell Medical College news release. After one year, mean PSA scores for this group had decreased by 47% and mean prostate volume had decreased by almost 18%. However, “the magnitude of reduction was significantly greater in men with benign prostate disease and significantly less in the 28% of patients whose prostate biopsy detected cancer.”
 
For phase II, 179 men who had received 5 mg finasteride or 0.5 mg dutasteride underwent biopsy only when their PSA changed by more than 0.4 ng/ml. Twenty-seven percent of these patients met this trigger point, slightly more than half of whom (54%) were diagnosed with cancer following biopsy (77% of this group had high-grade tumors – a Gleason score 7 or greater).
 
These results indicate that combining drug therapy with PSA testing may help physicians identify hard-to-detect cancers in some men (by sending them for biopsy following small changes in PSA score) while helping other men avoid unnecessary biopsies.
 

Further Reading
Treatment failure can be caused by a variety of factors, including misdiagnosis of the primary psychiatric complaint, the presence of one or more comorbid conditions, and nonadherence to medication plans.
When treating patients who have been diagnosed with cancer, you should consult with their oncologist to brainstorm interventions that can help your patient have the best possible quality of life.
Prolonged exposure therapy can help veterans with post-traumatic stress disorder overcome the fear, anxiety, and depression that can lead to avoidance behaviors and other responses that negatively impact quality of life.
App will help patients with diabetes log their hypoglycemic events and achieve better control of these events by becoming more aware of preceding signs and symptoms.
Provocative research raises the question of whether we should we look at Alzheimer’s disease as “type 3 diabetes.”
Presentation at CMHC 2014 provides updates on emerging classes of diabetes treatment, including preliminary data from current clinical trials.
In remarks delivered at the American Academy of Family Physicians 2014 Assembly, HHS Secretary Sylvia Mathews Burwell spoke about the ongoing response to the Ebola outbreak, improving health care delivery, the Affordable Care Act, and the Transforming Clinical Practice Initiative.
More Reading