Society Of Urologic Oncology Meeting Chemoprevention In 2008 What I Recommend To Patients

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology;  Clinical Trials / Drug Trials
Article Date: 31 May 2008 - 0:00 PDT

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ORLANDO, FL (UroToday.com) - Dr. Andriole addressed chemoprevention. Chemoprevention in prostate cancer is primarily approached with 5-α reductase inhibitors. The PCPT was the landmark study for testing this approach. The high Gleason score in the treated patients was problematic. He discussed 4 possible explanations. One reason might be that finasteride causes histological changes that alter the ability to read Gleason score. This has been refuted. Data suggests that finasteride may cause atrophy and inhibit the low grade tumors, he stated. Tumor volumes in dutasteride treated patients were 40% less compared to placebo in a study by Dr. Gleave. It is unlikely that finasteride is inducing more aggressive tumors, based on the data he showed. It is also possible that the higher grade detection is an artifact of smaller prostate volumes following therapy.

He stated that chemoprevention in a low risk population was not the best study design. Also, dutasteride with it's inhibition of a different isoform of 5-α reductase make it a potentially better agent. Cancer may have more of the type 1 isoform, compared to type 2 in BPH tissue. The REDUCE study has a different study design that when completed next year may prove promising.

He concluded that compared to other tumor types, chemoprevention is underutilized in prostate cancer and represents an opportunity for urologists to embrace. Predictive tools are needed to define the appropriate population for chemoprevention.

Presented by Gerald Andriole, Jr., MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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