Urological Oncology: Prostate Cancer

The document from 2008 examined the use of five-alpha-reductase inhibitors (5ARIs) like finasteride in preventing prostate cancer, focusing on the Prostate Cancer Prevention Trial (PCPT) which showed a 26% relative risk reduction in clinically detected prostate cancers with finasteride, but also an increase in high Gleason score tumors and sexual or endocrine side effects. The effects of 5ARIs were consistent across various demographics but limited to men with baseline PSA values under 4.0 ng/mL, and the impact on mortality was unclear. Additionally, the document compared transperineal and transrectal prostate biopsies in 246 patients, finding no significant differences in outcomes, suggesting the transrectal approach as simpler. It also noted a decrease in incidental prostate cancer detection during TURP procedures, likely due to effective screening. Furthermore, a study of 121 men post-radical prostatectomy found that interpersonal sensitivity negatively affected sexual functioning recovery, while sociability did not, highlighting the role of psychosocial factors in postoperative recovery. The editorial comments raised concerns about the increased risk of high-grade disease with finasteride and the importance of psychosocial considerations in treatment and recovery for localized prostate cancer.