Use of 5 -Reductase Inhibitors for Prostate Cancer

From: http://www.auanet.org/content/media/pcredinh.pdf
Use of 5 -Reductase Inhibitors for Prostate Cancer
Chemoprevention: American Society of Clinical Oncology/
American Urological Association 2008 Clinical Practice Guideline
Barnett S. Kramer, Karen L. Hagerty, Stewart Justman, Mark R. Somerfield,
Peter C. Albertsen,* William J. Blot, H. Ballentine Carter, Joseph P. Costantino,
Jonathan I. Epstein, Paul A. Godley,† Russell P. Harris, Timothy J. Wilt,
Janet Wittes,‡ Robin Zon and Paul Schellhammer§
From the National Institutes of Health, Bethesda, MD; American Society of Clinical Oncology, Alexandria, VA; University of Montana Liberal
Studies, Missoula, MT; University of Connecticut Health Center, Farmington, CT; International Epidemiology Institute, Rockville, MD; Johns
Hopkins University, Baltimore, MD; National Surgical Adjuvant Breast and Bowel Project, Pittsburgh, PA; University of North Carolina at
Chapel Hill, Chapel Hill, NC; University of Minnesota School of Medicine, Minneapolis, MN; Statistics Collaborative,Washington, DC;
Michiana Hematology Oncology, Granger, IN; and Eastern Virginia Medical School, Norfolk, VA
Approved by the American Society of Clinical
Oncology Board on July 21, 2008, and by the

American Urological Association Board on October
17, 2008.
This document is being reprinted as submitted
without editorial or independent peer
review by the Editors of The Journal of
Urology®.
This guideline was developed through a collaboration
between the American Society of Clinical
Oncology and the American Urological Association,
and has been published jointly by
invitation and consent in the Journal of Clinical
Oncology and The Journal of Urology®. No part
of this document may be reproduced or transmitted
in any form or by any means, electronic or
mechanical, including photocopy, recording or
any information storage and retrieval system,
without written permission by the American Society
of Clinical Oncology or the American Urological
Association.
* Financial interest and/or other relationship
with GlaxoSmithKline.
† Financial interest and/or other relationship
with GlaxoSmithKline.
‡ Financial interest and/or other relationship
with Merck.
§ Financial interest and/or other relationship
with Theralogix, Dendreon Corporation, Southwestern
Oncology Group and ContraVac.
See Editorial on page 000.
Purpose: To develop an evidence-based guideline on the use of 5- -reductase
inhibitors (5-ARIs) for prostate cancer chemoprevention.
Methods: The American Society of Clinical Oncology (ASCO) Health Services
Committee (HSC), ASCO Cancer Prevention Committee, and the American Urological
Association Practice Guidelines Committee jointly convened a Panel of
experts, who used the results from a systematic review of the literature to develop
evidence-based recommendations on the use of 5-ARIs for prostate cancer chemoprevention.
Results: The systematic review completed for this guideline identified 15 randomized
clinical trials that met the inclusion criteria, nine of which reported
prostate cancer period prevalence.

Conclusion: Asymptomatic men with a prostate-specific antigen (PSA) 3.0
ng/mL who are regularly screened with PSA or are anticipating undergoing
annual PSA screening for early detection of prostate cancer may benefit from a
discussion of both the benefits of 5-ARIs for 7 years for the prevention of prostate
cancer and the potential risks (including the possibility of high-grade prostate
cancer). Men who are taking 5-ARIs for benign conditions such as lower urinary
tract [obstructive] symptoms (LUTS) may benefit from a similar discussion,
understanding that the improvement of LUTS relief should be weighed with the
potential risks of high-grade prostate cancer from 5-ARIs (although the majority
of the Panel members judged the latter risk to be unlikely). A reduction of
approximately 50% in PSA by 12 months is expected in men taking a 5-ARI;
however, because these changes in PSA may vary across men, and within individual
men over time, the Panel cannot recommend a specific cut point to trigger
a biopsy for men taking a 5-ARI. No specific cut point or change in PSA has been
prospectively validated in men taking a 5-ARI.