Monitoring of Prostate-specific Antigen in Men with Benign Prostate Enlargement Receiving 5-alpha Reductase Inhibitors: a Non-interventional, Cross-sectional Study of Real-world Practice of Urologists in Spain and Brazil

Overview

Journal BMC Urol

Publisher Biomed Central

Date 2025 Jan 31

PMID 39891103

Authors

Juan Manuel Palacios

Pratiksha Kapse

Vanessa Cortes

Marcio Augusto Averbeck

Alberto Budia Alba

Suryakant Somvanshi

Danilo Souza Lima da Costa Cruz

Fiona Pereira

Affiliations

Soon will be listed here.

Abstract

Background: Inconsistent monitoring of prostate-specific antigen in patients receiving 5-alpha reductase inhibitors for lower urinary tract symptoms/benign prostate enlargement may affect prostate cancer outcomes. This study evaluated real-world practice among urologists treating patients receiving 5-alpha reductase inhibitors.

Methods: This non-interventional, cross-sectional study collected data from urologists in Spain (N = 100) and Brazil (N = 100) via a self-reporting questionnaire and patient record forms. Endpoints included: frequency/methodology of prostate-specific antigen monitoring, concerns about the effect of 5-alpha reductase inhibitors on prostate-specific antigen monitoring, triggers of prostate biopsy, and concerns when switching 5-alpha reductase inhibitor formulation.

Results: Over half of urologists monitored prostate-specific antigen every 6 months (Spain 59%, Brazil 58%). Preferred methods were the "doubling rule" (Spain 66%, Brazil 41%) and "increase from nadir" (Spain 28%, Brazil 43%). A minority of urologists monitored unadjusted values (Spain 3%, Brazil 11%) or did not monitor prostate-specific antigen (Spain 1%, Brazil 3%). Most urologists ranked the potential for 5-alpha reductase inhibitors to mask prostate cancer as their top concern (Spain 65%, Brazil 56%). The most selected trigger for prostate biopsy was "if doubled (adjusted) prostate-specific antigen level after 6 months of treatment is > 4 ng/mL" (Spain 39%, Brazil 37%). Many urologists were moderately/very concerned about the effect on prostate-specific antigen when switching 5-alpha reductase inhibitor formulation.

Conclusions: An unmet need exists for standard guidance and continuous education to support optimal monitoring and interpretation of prostate-specific antigen in patients with lower urinary tract symptoms/benign prostate enlargement treated with 5-alpha reductase inhibitors.

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