Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Finasteride to prevent prostate cancer : Should all men or only a high-risk subgroup be treated?

Vickers, Andrew J. ; Savage, Caroline J. and Lilja, Hans LU orcid (2010) In Journal of Clinical Oncology 28(7). p.1112-1116
Abstract

Purpose: Finasteride has been shown to reduce the incidence of prostate cancer. Yet the use of finasteride remains low, likely because of the risk of adverse effects. We sought to determine whether prostate-specific antigen (PSA) levels could identify a high-risk subgroup for which the benefits of finasteride treatment outweigh the potential harms. Patients and Methods: Raw data from the Prostate Cancer Prevention Trial were used to model chemopreventive treatment strategies: treat all men, treat no men, or treat a high-risk subgroup based on PSA level. We weighted the benefits (reduction in cancer rate) and harms (treatment rate) of each strategy using numbers-needed-to-treat thresholds - the maximum number of men a clinician would... (More)

Purpose: Finasteride has been shown to reduce the incidence of prostate cancer. Yet the use of finasteride remains low, likely because of the risk of adverse effects. We sought to determine whether prostate-specific antigen (PSA) levels could identify a high-risk subgroup for which the benefits of finasteride treatment outweigh the potential harms. Patients and Methods: Raw data from the Prostate Cancer Prevention Trial were used to model chemopreventive treatment strategies: treat all men, treat no men, or treat a high-risk subgroup based on PSA level. We weighted the benefits (reduction in cancer rate) and harms (treatment rate) of each strategy using numbers-needed-to-treat thresholds - the maximum number of men a clinician would treat with finasteride to prevent one cancer. Results: Of 9,058 men, 1,957 were diagnosed with prostate cancer during the 7-year study. For the end point of all cancers, including both for-cause and end-of-study biopsies, the optimal strategy is to treat all or nearly all men. To reduce risk of cancers detected through routine care, treating men with PSA > 1.3 or > 2 ng/mL is optimal. For example, treating only men with PSA > 2 ng/mL reduced the treatment rate by 83% and resulted in a cancer rate only 1.1% higher than treating all men. Conclusion: Clinicians wishing to reduce the risk of any biopsy-detectable prostate cancer should recommend finasteride to all men. Clinicians who believe that it is unnecessary to prevent all cancers, but that preventing those readily detectable by screening would be desirable, would be best off recommending finasteride only to a high-risk subgroup.

(Less)
Please use this url to cite or link to this publication:
author
; and
publishing date
type
Contribution to journal
publication status
published
in
Journal of Clinical Oncology
volume
28
issue
7
pages
1112 - 1116
publisher
American Society of Clinical Oncology
external identifiers
  • pmid:20124185
  • scopus:77949877667
ISSN
0732-183X
DOI
10.1200/JCO.2009.23.5572
language
English
LU publication?
no
id
91bae231-2384-48fd-9457-da53c12d10a5
date added to LUP
2022-12-06 15:42:15
date last changed
2024-04-04 13:49:05
@article{91bae231-2384-48fd-9457-da53c12d10a5,
  abstract     = {{<p>Purpose: Finasteride has been shown to reduce the incidence of prostate cancer. Yet the use of finasteride remains low, likely because of the risk of adverse effects. We sought to determine whether prostate-specific antigen (PSA) levels could identify a high-risk subgroup for which the benefits of finasteride treatment outweigh the potential harms. Patients and Methods: Raw data from the Prostate Cancer Prevention Trial were used to model chemopreventive treatment strategies: treat all men, treat no men, or treat a high-risk subgroup based on PSA level. We weighted the benefits (reduction in cancer rate) and harms (treatment rate) of each strategy using numbers-needed-to-treat thresholds - the maximum number of men a clinician would treat with finasteride to prevent one cancer. Results: Of 9,058 men, 1,957 were diagnosed with prostate cancer during the 7-year study. For the end point of all cancers, including both for-cause and end-of-study biopsies, the optimal strategy is to treat all or nearly all men. To reduce risk of cancers detected through routine care, treating men with PSA &gt; 1.3 or &gt; 2 ng/mL is optimal. For example, treating only men with PSA &gt; 2 ng/mL reduced the treatment rate by 83% and resulted in a cancer rate only 1.1% higher than treating all men. Conclusion: Clinicians wishing to reduce the risk of any biopsy-detectable prostate cancer should recommend finasteride to all men. Clinicians who believe that it is unnecessary to prevent all cancers, but that preventing those readily detectable by screening would be desirable, would be best off recommending finasteride only to a high-risk subgroup.</p>}},
  author       = {{Vickers, Andrew J. and Savage, Caroline J. and Lilja, Hans}},
  issn         = {{0732-183X}},
  language     = {{eng}},
  month        = {{03}},
  number       = {{7}},
  pages        = {{1112--1116}},
  publisher    = {{American Society of Clinical Oncology}},
  series       = {{Journal of Clinical Oncology}},
  title        = {{Finasteride to prevent prostate cancer : Should all men or only a high-risk subgroup be treated?}},
  url          = {{http://dx.doi.org/10.1200/JCO.2009.23.5572}},
  doi          = {{10.1200/JCO.2009.23.5572}},
  volume       = {{28}},
  year         = {{2010}},
}