Words of wisdom. Re: effect of dutasteride on the risk of prostate cancer.

摘要

A 24.4% relative reduction in prostate cancer (PCa) prevalence was shown previously in the Prostate Cancer Prevention Trial (PCPT) for treatment with finasteride, a type 2 5a-reductase inhibitor (5-ARI), versus placebo [1]. In the REDUCE trial, Andriole and colleagues randomized 8231 men at high risk of PCa (ie, 50-75 yr of age, serum prostate-specific antigen [PSA] 2.5-10.0 ng/ml, and one PCa-negative 6-12-core biopsy series in the previous 6 mo) to receive 0.5 mg dutasteride (a dual 5-ARI) daily or placebo for 4 yr. Participants were scheduled to undergo 10-core transrectal, ultrasound-guided biopsies at 24 mo and 48 mo. Of those, 6729 participants actually underwent biopsies or prostate surgery. Results shows that 659 cancers were detected in 3305 men receiving dutasteride (19.9%) versus 858 cancers detected in 3424 men receiving placebo (25.1%)-a 22.8% relative reduction of PCa incidence. Dutasteride exerted the strongest preventive effect for low-grade PCa. For high-grade PCa (Gleason score >7), the overall incidence in both groups was equal (6.8% vs 6.7%, respectively)