Finasteride and high-grade prostate cancer in the Prostate Cancer Prevention Trial.
💡 한 문장 핵심
Prostate Cancer Prevention Trial에서의 피나스테리드와 고등급 전립선암.
5/5 보강
TL;DR
Results suggest that high-grade cancer was detected earlier and was less extensive in the finasteride group than in the placebo group, and effects of finasterid on prostate volume and selective inhibition of low- grade cancer, rather than effects on tumor morphology, may have contributed to the increase in high- grade cancers with finasterides in the PCPT.
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📑 인용한 논문 (6) ▾
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연도별 인용 (2012–2025) · 합계 129
OpenAlex 토픽 ·
Prostate Cancer Diagnosis and Treatment
Prostate Cancer Treatment and Research
Urinary Bladder and Prostate Research
🇰🇷 한글 요약 🌐 Abstract
【연구 목적】
PCPT(전립선암 예방 임상시험)에서 피나스테리드(finasteride) 투여군에서 전체 전립선암은 감소했으나 고등급(high-grade) 전립선암은 증가한 현상이, 약물이 종양 형태에 미치는 영향 때문인지 아니면 전립선 크기 변화에 따른 검출 편향 때문인지를 규명하고자 했다.
【방법】
Gleason 점수 7~10점 생검·근치적 전립선절제술(radical prostatectomy) 검체에서 호르몬성 변화, 종양 범위 대리지표, 전립선 용적을 측정·비교하고, 생검과 절제술 간 등급 일치도를 분석했다(로지스틱 회귀, 양측 검정).
【주요 결과】
피나스테리드군은 전립선 용적이 유의하게 작았고(25.1 vs 34.4 cm³, P<.001), 양성 코어 비율·양측성·신경주위 침습 등 종양 범위 지표가 모두 더 낮았다. 생검에서 두드러진 고등급암 증가(42.7% vs 25.4%)는 절제술 검체에서는 크게 줄어(46.4% vs 38.6%, P=.10), 고등급암이 실제로 더 일찍·덜 진행된 상태에서 검출된 것으로 나타났다.
【임상적 시사점 (성형외과 의사 관점)】
이 논문은 성형외과 시술과 직접 관련은 없으나, 5α-환원효소 억제제인 피나스테리드는 남성형 탈모(androgenetic alopecia) 치료제로 모발이식·탈모 클리닉에서 흔히 처방된다는 점에서 의의가 있다. 약물이 전립선암 위험 자체를 높인다기보다 전립선 축소로 인한 검출 편향일 가능성이 크다는 점을 환자 상담 시 균형 있게 설명할 수 있으며, 장기 복용 환자에게는 PSA 수치가 낮게 측정될 수 있음을 함께 안내하는 것이 바람직하다.
[BACKGROUND] The Prostate Cancer Prevention Trial (PCPT) reported a decreased incidence of prostate cancer overall but an increase in the incidence of high-grade prostate cancer with finasteride compared with placebo. We assessed whether the increased high-grade prostate cancer associated with finasteride in the PCPT was due to finasteride's potential effects on tumor morphology or prostate size.
[METHODS] Prostate biopsies with Gleason score 8-10 (n = 90, finasteride; n = 52, placebo) were examined histologically for hormonal effects, and those with Gleason score 7-10 (n = 282, finasteride; n = 244, placebo) were examined for pathologic surrogates of disease extent. Prostate volumes were measured at biopsy. Samples from radical prostatectomies (n = 222, finasteride; n = 306, placebo) were examined for tumor grade and extent, and, where possible, grades at biopsy and prostatectomy were compared between the groups. Logistic regression was used to analyze differences between treatment groups with respect to pathologic criteria. All statistical tests were two-sided.
[RESULTS] Degenerative hormonal changes in high-grade biopsies were equivalent between the finasteride and placebo groups, but prostate volumes were lower in the finasteride group (median = 25.1 versus 34.4 cm3, P<.001). Pathologic surrogates for tumor extent were lower with finasteride than with placebo, including mean percentage of positive cores (34% versus 38%, P = .016), mean tumor linear extent (greatest [4.4 versus 4.8 mm, P = .19] and aggregate [7.6 versus 9.2 mm, P = .13]), bilaterality (22.8% versus 30.6%, P = .046), and perineural invasion (14.2% versus 20.3%, P = .07). Among patients who had prostatectomy, the finasteride-associated increase in high-grade disease (Gleason score > or = 7) at biopsy (42.7% finasteride versus 25.4% placebo, P<.001) was diminished at prostatectomy (46.4% finasteride versus 38.6% placebo, P = .10). Biopsy identified a greater proportion of patients with high-grade disease present at prostatectomy in the finasteride group than in the placebo group (69.7% versus 50.5%, P = .01). The rate of upgrading (from low-grade cancer at biopsy to high-grade cancer at prostatectomy) and pathologic stage at prostatectomy were similar in both groups.
[CONCLUSIONS] Effects of finasteride on prostate volume and selective inhibition of low-grade cancer, rather than effects on tumor morphology, may have contributed to the increase in high-grade cancers with finasteride in the PCPT. Although induction of high-grade cancer cannot be excluded, the results suggest that high-grade cancer was detected earlier and was less extensive in the finasteride group than in the placebo group.
[METHODS] Prostate biopsies with Gleason score 8-10 (n = 90, finasteride; n = 52, placebo) were examined histologically for hormonal effects, and those with Gleason score 7-10 (n = 282, finasteride; n = 244, placebo) were examined for pathologic surrogates of disease extent. Prostate volumes were measured at biopsy. Samples from radical prostatectomies (n = 222, finasteride; n = 306, placebo) were examined for tumor grade and extent, and, where possible, grades at biopsy and prostatectomy were compared between the groups. Logistic regression was used to analyze differences between treatment groups with respect to pathologic criteria. All statistical tests were two-sided.
[RESULTS] Degenerative hormonal changes in high-grade biopsies were equivalent between the finasteride and placebo groups, but prostate volumes were lower in the finasteride group (median = 25.1 versus 34.4 cm3, P<.001). Pathologic surrogates for tumor extent were lower with finasteride than with placebo, including mean percentage of positive cores (34% versus 38%, P = .016), mean tumor linear extent (greatest [4.4 versus 4.8 mm, P = .19] and aggregate [7.6 versus 9.2 mm, P = .13]), bilaterality (22.8% versus 30.6%, P = .046), and perineural invasion (14.2% versus 20.3%, P = .07). Among patients who had prostatectomy, the finasteride-associated increase in high-grade disease (Gleason score > or = 7) at biopsy (42.7% finasteride versus 25.4% placebo, P<.001) was diminished at prostatectomy (46.4% finasteride versus 38.6% placebo, P = .10). Biopsy identified a greater proportion of patients with high-grade disease present at prostatectomy in the finasteride group than in the placebo group (69.7% versus 50.5%, P = .01). The rate of upgrading (from low-grade cancer at biopsy to high-grade cancer at prostatectomy) and pathologic stage at prostatectomy were similar in both groups.
[CONCLUSIONS] Effects of finasteride on prostate volume and selective inhibition of low-grade cancer, rather than effects on tumor morphology, may have contributed to the increase in high-grade cancers with finasteride in the PCPT. Although induction of high-grade cancer cannot be excluded, the results suggest that high-grade cancer was detected earlier and was less extensive in the finasteride group than in the placebo group.
- 표본수 (n) 90
- p-value P<.001
- p-value P = .016
【연구 목적】 PCPT(전립선암 예방 임상시험)에서 피나스테리드(finasteride) 투여군에서 전체 전립선암은 감소했으나 고등급(high-grade) 전립선암은 증가한 현상이, 약물이 종양 형태에 미치는 영향 때문인지 아니면 전립선 크기 변화에 따른 검출 편향 때문인지를 규명하고자 했다.
APA 7
Lucia, M. S., Epstein, J. I., Goodman, P. J., Darke, A. K., Reuter, V. E., Civantos, F., Tangen, C. M., Parnes, H. L., Lippman, S. M., FG, L. R., Kattan, M. W., Crawford, E. D., Ford, L. G., Coltman, C. A., & Thompson, I. M. (2007). Finasteride and high-grade prostate cancer in the prostate cancer prevention trial.. Journal of the National Cancer Institute, 99(18), 1375-83. https://doi.org/10.1093/jnci/djm117
Vancouver
Lucia MS, Epstein JI, Goodman PJ, Darke AK, Reuter VE, Civantos F, et al. Finasteride and high-grade prostate cancer in the Prostate Cancer Prevention Trial. Jour. Nati. Canc. Inst.. 2007;99(18):1375-83. doi:10.1093/jnci/djm117
AMA 11
Lucia MS, Epstein JI, Goodman PJ, Darke AK, Reuter VE, Civantos F, et al. Finasteride and high-grade prostate cancer in the Prostate Cancer Prevention Trial. Jour. Nati. Canc. Inst.. 2007;99(18):1375-83. doi:10.1093/jnci/djm117
Chicago
Lucia, M. S., Epstein, J. I., Goodman, P. J., Darke, A. K., Reuter, V. E., Civantos, F., Tangen, C. M., Parnes, H. L., Lippman, S. M., FG, L. R., and .... 2007. "Finasteride and high-grade prostate cancer in the Prostate Cancer Prevention Trial." Journal of the National Cancer Institute 99 (18): 1375-83. https://doi.org/10.1093/jnci/djm117
MLA 9
Lucia, M. S., et al. "Finasteride and high-grade prostate cancer in the Prostate Cancer Prevention Trial." Journal of the National Cancer Institute, vol. 99, no. 18, 2007, pp. 1375-83. doi:10.1093/jnci/djm117.
PMID
17848673 ↗
🏷️ 키워드 / MeSH 📖 같은 키워드 OA만
- Black or African American
- Aged
- Anticarcinogenic Agents
- Bias
- Biopsy
- Needle
- Confounding Factors
- Epidemiologic
- Enzyme Inhibitors
- Finasteride
- Humans
- Incidence
- Logistic Models
- Male
- Middle Aged
- Prostate-Specific Antigen
- Prostatectomy
- Prostatic Neoplasms
- Severity of Illness Index
- United States
- White People
인용 관계
그래프 OA 노드: 8/8 (100%)
· 참조 0편 · 후속 8편
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