Advances in Clinical and Experimental Medicine
2014, vol. 23, nr 1, January-February, p. 79–84
Publication type: original article
Language: English
The Impact of 5-Alpha Reductase Inhibitor vs. Alpha-1 Adrenergic Receptor Antagonists on Course of Prostate Premalignant Conditions
1 Urology Department in the Medical and Dentistry Division in Zabrze, Medical University of Silesia in Katowice, Poland
Abstract
Background. Prostate intraepithelial neoplasm and atypical small acinar proliferation are considered prostate premalignant conditions. Such a diagnosis impacts further follow-up significantly as early detection of prostate cancer is of utmost importance. Alpha-1 adrenergic receptor antagonists (i.e. doxazosiunum) and inhibitors of 5-alpha reductase (Finasteride) showed some efficacy in prevention of prostate cancer development.
Objectives. To assess the impact of both abovementioned drugs on prostate premalignant conditions.
Material and Methods. From January 2008 till September 2012, 213 patients with one of the abovementioned premalignant condition were retrospectively evaluated. After diagnosis they were assigned to group 1 (n-126)– treated with Finasteride or to group 2 (n-87)-treated with Doxazosinum. Every 6–7 months rebiopsies were conducted in each patient. Rate of remission and progression was assessed.
Results. In comparison between group 1 and 2 the rate of remission was 35.7% (n-45) vs. 18.4% (n-16) (p = 0.005). In terms of progression, the difference between 1st and 2nd group of patients was 7.1% (n-9) vs. 5.7% (n-5) (p = 0.68).
Conclusion. Remission of prostate premalignant condition is efficacious with Finasteride and not with Doxazosinum. However, in terms of progression there were no differences among both drugs.
Key words
prostate cancer, prostate intraepithelial neoplasia, atypical small acinar proliferation, chemoprevention
References (26)
- Park S, Shinohara K, Grossfeld GB, Caroll RH: Prostate cancer detection in men with HG PIN or ASAP. J Urol 2001, 165, 1409–1413.
- Girosol MS, Cookson MJ, Putzi P: Significance of atypical and suspicious ASAP and HG PIN on prostate biopsy. Implication for cancer detection and biopsy strategy. J Urol 2006, 175, 929–933.
- Allen CA, Chan JY, Epstein JI, Hokore H: Long-term follow-up of men with initial atypical prostate needle biopsy. J Urol 2001, 165, Supl 4 Abs 405.
- Goeman L, Janian S, Panetta D: Is low grade prostatic intraepithelial neoplasia a risk factor for cancer? Prostate Cancer and Prostatic Diseases 2003, 6, 305– 310.
- Haggeman MJ, Makoska JA, Wojno KJ, Oesterling JE: The relationship between prostatic intraepithelial neoplasia and prostate cancer. Critical issues. J Urol 1997, 158, 12–17.
- Zuniga A, Lockword G, Tas A: Prostate specific antigen level is a predictor of cancer among men with HG PIN but not among men with ASAP. J Urol 2008, 179, Supl 4, Abs 1239.
- Sadhu S, Walker G, Jarmułowicz M, Kaisary A: The investigation using morphometric criteria. The relationship between HG PIN, prostate cancer and serum PSA. BJU Intr 2004, 94, Supl 2A, Abs UP 6–15.
- Kristal AH, Stanford M, Cohen JE: Vitamin and mineral supplement use is associated with reduced risk of prostate cancer. Cancer Epidemiol Biomarkers Prev 1999, 8, 889–892.
- Sakr WA: PIN: a marker for high-risk group and potential target for chemoprevention. Eur Urol 1999, 35, 474–478.
- Fryczkowski M, Szczębara M, Kupilas A: A comparison of tumor progression in patients with simultaneous prostate cancer and prostate premalignant conditions to patients with prostate cancer alone. Centr Eur J Urol 2009, 63, 20–24.
- Janianu S, Goeman L, Roskama T: The effect of chemoprevention on PSA and clinical management in patients with high-grade prostatic intraepithelial neoplasia. Eur Urol 1994, 67, Supl 3, Abs 259.
- Lefkovitz GK,Taneja SS, Brown J: Follow-up internal prostate biopsy 3-years after diagnosis of high-grade prostatic intraepithelial neoplasia is associated with high likelihood of prostate cancer independent of change in prostate specific antigen levels. J Urol 2002, 168, 1415–1418.
- Morgentaler A, Rhoden EI: Prevalence of prostate cancer among hypogonadal men with prostate specific antigen of 4 ng/mL or less. Urology, 2006, 68, 1263–1268.
- Moore CK, Karikehalli S, Mauzer T: Prognostic significance of high-grade prostatic intraepithelial neoplasia and atypical small acinar proliferation in the contemporary era. J Urol 2003, 175, 70–72.
- Kyprianou N, Bemmintg CM: Suppression of human prostate cancer cell growth by alpha-1 adrenoceptor antagonists Doxazosin and Terazosin via induction of apoptosis. Cancer Res 2000, 60, 2606–2610.
- Harris AM, Warber BW, Wilson JM: Effect of alpha-1 adrenoreceptor antagonist exposure on prostate cancer incidence an observational cohort study. J Urol 2007, 178, 2178–3180.
- Weng L, Brown J, Eng C: PTEN induces apoptosis and cell cycle arrest through phosphoinosito-3 kinase/Akt – dependent and independent pathways. Hum Mol Genet 2001, 10, 237–242.
- Murtola TJ, Tamela TLJ, Maattanen L: Prostate cancer incidence among Finasteride and a-blocker users in Finish Prostate Cancer Screening Trial. Brit J C ancer 2009, 101, 843–848.
- Slem CE, Cole RJ, Skiner EC: The effect of Finasteride on prostate gland peripheral zone histology and proliferation rates in men at high-risk for prostate cancer. J Urol 1997, 157, 228–252.
- Thompson IM, Lucia MS, Redman AW: Finasteride decreases risk of prostate intraepithelial neoplasia. J Urol 2007, 178, 107–110.
- Clarc IC, Marshal JH: Randomized controlled chemoprevention trials in population at very high risk for prostate cancer (Elevated PSA and HG PIN). Urology, 2001, 57, 185–189.
- Bono AV, Mazzuccelli R, Ferrari L: Bicalutamide 50 mg monotherapy in patients with isolated high-grade PIN. Findings in repeat biopsies at 6 month. J C lin Pathol 2007, 60, 443–446.
- Braussi M, Cartagnetti G, Paracjin G: Immediate radical prostatectomy for patients with atypical small acinar proliferation is not an overtreatment. BJU Inter 2004, 94, supl 2, abs UP 9–30.
- Gaworow A, Puskhar D, Kosko I, Kirilina M: Are the volume of HG PIN and number of biopsies with HG PIN predictive for prostate cancer? Eur Urol 2006, 69, Supl 3/2, Abs 871.
- Aleksander EE, Qion J, Wollan PC: Prostate intraepithelial neoplasia results is elevated serum prostatic specific antigen levels. Urology 1996, 47, 693–698.
- Ronnett BM, Carmichael MJ, Carter HM, Epstein JI: Does high-grade prostatic intraepithelial neoplasia results in elevated serum prostate specific antigen levels? J Urol 1993, 150, 386–389.


