Impact of Enlarged Prostate Treatment on Prostate Cancer Outcomes

Understanding Enlarged Prostate

An enlarged prostate, medically known as benign prostatic hyperplasia (BPH), can lead to various uncomfortable urinary symptoms. This condition results from the overgrowth of prostate cells and is a common occurrence as men age, affecting approximately 27 million men in the United States. While benign, prostate enlargement does not metastasize to other areas of the body.

Factors such as advancing age, obesity, and a sedentary lifestyle may heighten the risk of developing an enlarged prostate. Symptoms typically include a frequent or urgent need to urinate, increased nighttime urination, difficulty in passing urine, and a weak or slow urine stream.

Treatment Options for Enlarged Prostate

The most common treatment for this condition involves a class of medications known as 5-alpha reductase inhibitors (5-ARIs), which include finasteride (Proscar) and dutasteride (Avodart).

Research Findings on 5-ARIs and Prostate Cancer

Study Overview

A recent study conducted by researchers at The University of California San Diego and published in JAMA Internal Medicine explored whether the use of 5-ARIs before a prostate cancer diagnosis correlates with poorer outcomes. The study analyzed data from over 80,000 patients within the Veterans Affairs San Diego Healthcare System from 2001 to 2015, identifying that approximately 10.6% of these men had been prescribed 5-ARIs at least one year prior to their prostate cancer diagnosis.

Key Findings

The results revealed a significant difference in the timing of prostate cancer diagnoses. Men who had used 5-ARIs were diagnosed with prostate cancer an average of 3.6 years after the initial signs of prostate gland enlargement, compared to just 1.4 years for those who did not receive these medications. Additionally, men taking 5-ARIs presented with more advanced disease at the time of diagnosis. They showed a higher likelihood of having a Gleason score of eight or more, clinical stage T3 or higher, node-positive, and metastatic disease compared to their counterparts who were not treated with 5-ARIs.

Conclusion

This study highlights the potential implications of pre-diagnostic treatment with 5-ARIs on prostate cancer outcomes, emphasizing the need for further research in this area.

Reference

Sarkar, R.R. et al. Association of Treatment With 5α-Reductase Inhibitors With Time to Diagnosis and Mortality in Prostate Cancer. JAMA Internal Medicine, DOI: 10.1001/jamainternmed.2019.0280.
Written by Man-tik Choy, Ph.D.