PCPT, MTOPS and the use of 5ARIs: a Canadian consensus regarding implications for clinical practice
DOI:
https://doi.org/10.5489/cuaj.33Abstract
Objectives: Two large, recently published, definitive trials evaluated the benefitsof 5-alpha reductase inhibitors (5ARIs). The Prostate Cancer Prevention Trial(PCPT) tested the effect of finasteride for prostate cancer prevention and the Medical Therapy of Prostatic Symptoms (MTOPS) tested its effect in benign prostatic hyperplasia(BPH). Both trials were strongly positive. However, the role of 5ARIs inthe clinical management of patients remains controversial. The consensus conference,which forms the basis for this report, attempted to develop an expertopinion, based on these studies, as to the optimal use of 5ARIs in patient management.Methods: The Canadian Consensus Meeting, organized by the Canadian Urology Research Consortium and the Canadian Urologic Oncology Group, held inToronto on May 7, 2006, focused on the new data from the PCPT and the MTOPS study. Internationally recognized experts and clinicians discussedthe implications of these data on clinical practice and issued a recommendationon the optimal management of patients with BPH.
Results: The Consensus meeting agreed on the following recommendations:
1. The overall results from the PCPT and MTOPS studies are of importanceto the urologic, as well as to the greater medical, community.
2. Prostate management guidelines should be updated to include the resultsfrom both the MTOPS and the PCPT studies.
3. In the PCPT, the incidence of high-grade cancer was higher in the finasteridetreatedgroup (6.4%), compared with the placebo group (5.1%). Subsequentanalyses strongly suggest that this increased prevalence was owing to a detectionbias caused by the reduction in prostate volume in patients takingfinasteride, compared with patients taking placebo. This resulted in animproved detection at biopsy of high-grade cancer in the finasteride group.
4. In men who have large prostates and lower urinary tract symptoms (LUTS),5ARIs should be considered, both for the treatment of BPH and for prostatecancer risk reduction.
5. For men who are concerned about prostate cancer, it is appropriate to discusschemoprevention with finasteride.
6. Urologists are encouraged to disseminate these recommendations amongother healthcare professionals.
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