© The Author 2006. Published by Oxford University Press.
ARTICLE |
Effect of Finasteride on the Sensitivity of PSA for Detecting Prostate Cancer
Affiliations of authors: Department of Urology, the University of Texas Health Science Center at San Antonio, San Antonio, TX (IMT, DPA); Southwest Oncology Group Statistical Center and Fred Hutchinson Cancer Research Center, Seattle, WA (CC, PJG, CMT); Department of Clinical Cancer Prevention, The University of Texas M. D. Anderson Cancer Center, Houston, TX (SML); Department of Pathology, University of Colorado HSC, Denver, CO (MSL); Division of Cancer Prevention, National Cancer Institute, Bethesda, MD (HLP); The Southwest Oncology Group, San Antonio, TX (CAC)
Correspondence to: Ian M. Thompson, MD, Department of Urology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229 (e-mail: thompsoni{at}uthscsa.edu).
Background: In the Prostate Cancer Prevention Trial (PCPT), men receiving finasteride had a 24.8% lower risk of prostate cancer than men receiving placebo but a higher risk of high-grade cancer. We examined the impact of finasteride on the sensitivity and area under the receiver operating characteristic curve (AUC) of prostate-specific antigen (PSA) for detecting prostate cancer. Methods: We studied men in the placebo and finasteride groups of the PCPT who had a prostate biopsy and concurrent PSA tests during the 7-year study. We compared the placebo and finasteride groups for sensitivity and AUC of PSA for the detection of all prostate cancer, of Gleason grade 7 or higher prostate cancer, and of Gleason grade 8 or higher prostate cancer. All statistical tests were two-sided. Results: Of 5112 men in the placebo group, prostate cancer was detected in 1111. Gleason tumor grade was available for 1100 men, of whom 240 had grade 7 or higher and 55 had grade 8 or higher. Of 4579 men in the finasteride group, 695 had prostate cancer. Gleason grade was available for 686 men, of whom 264 had grade 7 or higher and 81 had grade 8 or higher. The AUC of PSA for all outcomes was greater for the finasteride group than the placebo group. For detecting prostate cancer versus no cancer, the AUCs were 0.757 and 0.681, respectively (P<.001); for detecting Gleason grade 
7 versus 
6 or no cancer, the AUCs were 0.838 and 0.781, respectively (P = .003); and for detecting Gleason grade 8 versus 7 or no cancer, the AUCs were 0.886 and 0.824, respectively (P = .071). The sensitivity of PSA was higher for men in the finasteride group than in the placebo group at all PSA cutoffs matched by specificity. Conclusions: PSA had statistically significantly better sensitivity and AUC for detecting prostate cancer in the finasteride arm of the PCPT than in the placebo arm. This bias would be expected to contribute to greater detection of all grades of prostate cancer with finasteride.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  B. S. Kramer, K. L. Hagerty, S. Justman, M. R. Somerfield, P. C. Albertsen, W. J. Blot, H. Ballentine Carter, J. P. Costantino, J. I. Epstein, P. A. Godley, et al. Use of 5-{alpha}-Reductase Inhibitors for Prostate Cancer Chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline J. Clin. Oncol., March 20, 2009; 27(9): 1502 - 1516. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. S. Kramer Prostate Cancer Prevention: The Role of 5-alpha-reductase Inhibitors ASCO Educational Book, January 1, 2009; 2009(1): 65 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Klein and I. M. Thompson Current Status of Chemoprevention of Prostate Cancer ASCO Educational Book, January 1, 2009; 2009(1): 276 - 281. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Kristal Are Clinical Trials the "Gold Standard" for Cancer Prevention Research? Cancer Epidemiol. Biomarkers Prev., December 1, 2008; 17(12): 3289 - 3291. [Full Text] [PDF]
|
|
|
|
 |
|
 R. J. Hamilton, K. C. Goldberg, E. A. Platz, and S. J. Freedland The Influence of Statin Medications on Prostate-specific Antigen Levels J Natl Cancer Inst, November 5, 2008; 100(21): 1511 - 1518. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. M. Thompson, C. M. Tangen, and A. R. Kristal Prostate-Specific Antigen: A Misused and Maligned Prostate Cancer Biomarker J Natl Cancer Inst, November 5, 2008; 100(21): 1487 - 1488. [Full Text] [PDF]
|
|
|
|
 |
|
 M. S. Lucia Abstract CN01-02: The Prostate Cancer Prevention Trial: An update on pathology Cancer Prevention Research, November 1, 2008; 1(7_MeetingAbstracts): CN01-02 - CN01-02.
|
|
|
|
|
|
M. S. Lucia, A. K. Darke, P. J. Goodman, F. G. La Rosa, H. L. Parnes, L. G. Ford, C. A. Coltman Jr., and I. M. Thompson Pathologic Characteristics of Cancers Detected in the Prostate Cancer Prevention Trial: Implications for Prostate Cancer Detection and Chemoprevention Cancer Prevention Research, August 1, 2008; 1(3): 167 - 173. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. Logothetis and P. F. Schellhammer High-Grade Prostate Cancer and the Prostate Cancer Prevention Trial Cancer Prevention Research, August 1, 2008; 1(3): 151 - 152. [Full Text] [PDF]
|
|
|
|
|
|
M. W. Redman, C. M. Tangen, P. J. Goodman, M. S. Lucia, C. A. Coltman Jr., and I. M. Thompson Finasteride Does Not Increase the Risk of High-Grade Prostate Cancer: A Bias-Adjusted Modeling Approach Cancer Prevention Research, August 1, 2008; 1(3): 174 - 181. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Jayachandran and S. J. Freedland Prevention of Prostate Cancer: What We Know and Where We Are Going American Journal of Men's Health, June 1, 2008; 2(2): 178 - 189. [Abstract] [PDF]
|
|
|
|
|
|
D. Ulmert, A. M. Serio, M. F. O'Brien, C. Becker, J. A. Eastham, P. T. Scardino, T. Bjork, G. Berglund, A. J. Vickers, and H. Lilja Long-Term Prediction of Prostate Cancer: Prostate-Specific Antigen (PSA) Velocity Is Predictive but Does Not Improve the Predictive Accuracy of a Single PSA Measurement 15 Years or More Before Cancer Diagnosis in a Large, Representative, Unscreened Population J. Clin. Oncol., February 20, 2008; 26(6): 835 - 841. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Lucia, J. I. Epstein, P. J. Goodman, A. K. Darke, V. E. Reuter, F. Civantos, C. M. Tangen, H. L. Parnes, S. M. Lippman, F. G. La Rosa, et al. Finasteride and High-Grade Prostate Cancer in the Prostate Cancer Prevention Trial J Natl Cancer Inst, September 19, 2007; 99(18): 1375 - 1383. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. C. Cohen, K. S. Liu, N. L. Heyden, A. D. Carides, K. M. Anderson, A. G. Daifotis, and P. H. Gann Detection Bias Due to the Effect of Finasteride on Prostate Volume: A Modeling Approach for Analysis of the Prostate Cancer Prevention Trial J Natl Cancer Inst, September 19, 2007; 99(18): 1366 - 1374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. M. Thompson, D. Pauler Ankerst, C. Chi, P. J. Goodman, C. M. Tangen, S. M. Lippman, M. S. Lucia, H. L. Parnes, and C. A. Coltman Jr Prediction of Prostate Cancer for Patients Receiving Finasteride: Results From the Prostate Cancer Prevention Trial J. Clin. Oncol., July 20, 2007; 25(21): 3076 - 3081. [Abstract] [Full Text] [PDF]
|
|