Switching Prostate Meds Can Drive Up PSA Velocity

Study cautions that apparent increase in PSA velocity creates risk of unnecessary biopsy
By Jeff Muise
HealthDay Reporter

THURSDAY, July 1 (HealthDay News) -- In patients with benign prostatic hyperplasia (BPH), switching from one 5α-reductase inhibitor to another can result in a significant change in prostate-specific antigen (PSA) velocity that may prompt physicians to order unnecessary biopsies, according to research published in the July issue of The Journal of Urology.

Brian T. Helfand, M.D., of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues identified 227 patients with BPH who had been treated with two or more 5α-reductase inhibitors. The patients were grouped based on the particular 5α-reductase inhibitor switches they made, and changes in PSA velocity were compared.

Seventy-seven patients changed from Proscar to generic finasteride; 49 patients changed from Proscar to dutasteride; 21 patients switched from dutasteride to Proscar; and eight patients switched from dutasteride to generic finasteride. The researchers found significant increases in PSA velocity in the dutasteride-to-finasteride, the dutasteride-to-Proscar, and the Proscar-to-finasteride groups. In more than a third of the patients, the increases were larger than 0.35 ng/mL per year, which indicates a PSA velocity threshold above which a physician typically will recommend a prostate biopsy.

"Results confirm that changing 5α-reductase [inhibitor] drugs can be associated with a clinically significant change in PSA velocity. These PSA velocity changes could place patients at risk for unnecessary prostate biopsy. Additional prospective studies are warranted," the authors write.

Study authors disclosed financial interests in and/or other relationships with GlaxoSmithKline, Pfizer, Lilly ICOS, Sanofi-Aventis, and Allergan.

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