How Do 5-Alpha-Reductase Inhibitors Change PSA Density in Patients on Active Surveillance?

    April 2024 in “ ˜The œJournal of urology/˜The œjournal of urology ”
    L.A. Webb, Gabriela M. Diaz, Syed N. Rahman, Ghazal Khajir, Preston Sprenkle
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    Studysummary This study observed that although 5-alpha-reductase inhibitors reduce PSA density in patients on active surveillance for prostate cancer, those who progress to more serious disease still show higher PSA densities, suggesting these inhibitors accentuate differences in clinically significant cases. Our plain-language summary of this paper — not a Tressless recommendation.
    The study investigated the impact of 5-alpha-reductase inhibitors (5ARIs) on PSA Density (PSAD) in patients under active surveillance (AS) for prostate cancer. Data from 445 patients, including 47 who took 5ARIs, were analyzed. Results showed that while 5ARIs reduce PSAD, patients who progressed to GG2+ disease or required treatment had significantly higher PSADs compared to those who did not progress. Specifically, median PSADs were 0.139 for those progressing to GG2+ and 0.190 for those needing treatment, versus 0.074 for non-progressors. The study suggests that 5ARIs may help identify patients with clinically significant disease, though further research is needed to establish PSAD cutoffs for biopsy decisions in patients on 5ARIs.
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