Estimating the Effect of Finasteride on Kallikrein Marker Levels in Blood and the Use of Converted Markers in the Four-Kallikrein Model

    March 2026 in “ European Urology Focus
    Emily Vertosick, Phyllis J. Goodman, Catherine M. Tangen, Cathee Till, Ian M. Thompson, M. Scott Lucia, James Eastham, Hans Lilja, Andrew J. Vickers
    TLDR Finasteride improves prostate cancer prediction by adjusting kallikrein marker levels.
    The study investigated the impact of finasteride, a 5-α-reductase inhibitor, on kallikrein markers in blood and its implications for prostate cancer screening using the four-kallikrein (4K) model. Analyzing 500 participants from the Prostate Cancer Prevention Trial, the study found that finasteride use halved total PSA and human kallikrein 2 levels, while free PSA and intact PSA were slightly more than halved. Adjusted marker levels improved the 4K model's ability to predict high-grade prostate cancer on biopsy, with an AUC of 0.734 compared to 0.595 for adjusted total PSA alone. The 4K model demonstrated the highest net benefit for risk thresholds of ≥7%, suggesting its utility in informing prostate biopsy decisions for men on 5-ARIs.
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