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Das „Prostate Cancer Prevention Trial“ (PCPT)

Die Bedeutung für den klinischen Alltag

The Prostate Cancer Prevention Trial (PCPT)

Relevance for clinical practice

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Zusammenfassung

Das „Prostate Cancer Prevention Trial“ (PCPT) ist die erste große Interventionsstudie, die gezielt auf die Prävention eines Prostatakarzinoms ausgerichtet war. Insgesamt wurden 18.882 Männer >55 Jahre mit einem PSA-Wert von <3,0 ng/ml in einen Kontroll- und einen Behandlungsarm (Finasterid 5 mg/Tag für 7 Jahre) randomisiert. Trotz einer Reduktion des Nachweises von Prostatakarzinomen um rund 25% wurden die Ergebnisse überaus kontrovers diskutiert. Dies war auf den vermehrten Nachweis von aggressiven Prostatakarzinomen zurückzuführen. Inzwischen liegen die Ergebnisse von umfangreichen Nachuntersuchungen vor, die darauf hinweisen, dass dieser Effekt wahrscheinlich auf einem optimierten Tumornachweis in der durch Finasterid verkleinerten Prostata beruht. Weitere Ergebnisse der Aufarbeitung von PCPT zeigen, dass die Einnahme von Finasterid die Diagnostik und den histopathologischen Nachweis von Prostatakarzinomen nicht beeinträchtigt. Neben einer Reduktion von Prostatakarzinomen fand sich auch eine Verminderung von Präneoplasien (PIN) unter Finasterid. Ziel künftiger Bemühungen muss es nun sein, Risikogruppen zu definieren, die von einer Chemoprävention mit einem 5α-Reduktasehemmer in besonderer Weise profitieren.

Abstract

The Prostate Cancer Prevention Trial (PCPT) has been the first interventional trial directly aimed at the prevention of prostate cancer. A total of 18,882 men over 55 years with a PSA serum level less than 3.0 ng/ml were randomized to receive either the 5-α-reductase inhibitor finasteride 5 mg/day or placebo for 7 years. Despite a 25% reduction of prostate cancers in the treatment arm the results were discussed controversially. This criticism was mainly due to the observation of significantly more high-grade cancers in the finasteride group. Meanwhile, results of extensive follow-up analyses have been published suggesting that this finding is most likely due to optimized tumor detection in smaller glands. Further work-up demonstrated that PSA diagnosis and the histopathological examination were not compromised by finasteride. Furthermore, in addition to a decrease of prostate cancer the amount of prostatic intraepithelial dysplasia (PIN) was also reduced under finasteride. Future research must now aim at defining high-risk groups specifically profiting from chemoprevention with a 5-α-reductase inhibitor.

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Literatur

  1. Thompson IM, Goodman PJ, Tangen CM et al. (2003) The influence of finasteride on the development of prostate cancer. N Engl J Med 349: 215–224

    Article  PubMed  CAS  Google Scholar 

  2. Thompson IM, Pauler DK, Goodman PJ et al. (2004) Prevalence of prostate cancer among men with a prostate-specific antigen level ≤4.0 ng per milliliter. N Engl J Med 350: 2239–2246

    Article  PubMed  CAS  Google Scholar 

  3. Andriole G, Bostwick D, Brawley O et al. REDUCE Study Group (2004) Chemoprevention of prostate cancer in men at high risk: rationale and design of the reduction by dutasteride of prostate cancer events (REDUCE) trial. J Urol 172: 1314–1317

    Article  PubMed  CAS  Google Scholar 

  4. Scardino P (2003) The prevention of prostate cancer – the dilemma continues. N Engl J Med 349: 297–299

    Article  PubMed  Google Scholar 

  5. Ian Thompson (2006) The prostate cancer prevention trial – update. Prostate Cancer Symp, San Francisco, Feb 24–26, 2006

  6. Kulkarni GS, Al-Azab R, Lockwood G et al. (2006) Evidence for a biopsy derived grade artifact among larger prostate glands. J Urol 175: 505–509

    Article  PubMed  Google Scholar 

  7. Ankerst DP, Thompson IM (2006) New answers from the Prostate Cancer Prevention Trial on the chemoprevention of prostate cancer. Arch Ital Urol Androl 78: 154–156

    PubMed  Google Scholar 

  8. Klein EA, Tangen CM, Goodman PJ et al. (2005) Assessing benefit and risk in the prevention of prostate cancer: the prostate cancer prevention trial revisited. J Clin Oncol 23: 7388–7390

    Article  Google Scholar 

  9. Teillac P, Abrahamsson PA (2006) The prostate cancer prevention trial and its implications for clinical practise: a European consensus. Eur Urol 5(Suppl): 640–646

    Article  Google Scholar 

  10. Stellungnahme des Arbeitskreises Prävention, Umwelt und Komplementärmedizin (PUK) und des Arbeitskreises Onkologie (AKO) der Akademie der Deutschen Urologen (2006) Chemoprävention des Prostatakarzinoms – eine Neubewertung. Blickpunkt. Der Mann 4: 47

    Google Scholar 

  11. Imamov O, Lopatkin NA, Gustafsson JA (2004) Estrogen receptor beta in prostate cancer. N Engl J Med 351: 2773–2774

    Article  PubMed  Google Scholar 

  12. Thompson IM, Chi C, Goodman P et al. (2006) Effect of finasteride on the sensitivity of PSA for detecting prostate cancer. J Natl Cancer Inst 98: 1128–1133

    Article  PubMed  CAS  Google Scholar 

  13. Bostwick DG, Qian J, Civantos F et al. (2004) Does finasteride alter the pathology of the prostate and cancer grading? Clin Prostate Cancer 2: 228–235

    PubMed  CAS  Google Scholar 

  14. Andriole G, Bostwick D, Civantos F et al. (2005) The effects of 5alpha-reductase inhibitors on the natural history, detection and grading of prostate cancer: current state of knowledge. J Urol 174: 2098–2104

    Article  PubMed  CAS  Google Scholar 

  15. Eskicorapci SY, Baydar DE, Akbal C et al. (2004) An extended 10-core transrectal ultrasonography guided prostate biopsy protocol improves the detection of prostate cancer. Eur Urol 45: 444–449

    Article  PubMed  Google Scholar 

  16. Singh H, Canto EI, Shariat SF et al. (2004) Improved detection of clinically significant, curable prostate cancer with systematic 12-core biopsy. J Urol 171: 1089–1092

    Article  PubMed  Google Scholar 

  17. Thompson IM, Lucia MS, Redman MW et al. (2007) Finasteride decreases the risk of prostatic intraepithelial neoplasia. J Urol 178: 107–109

    Article  PubMed  Google Scholar 

  18. Schröder FH, Roobol MJ, Van Leenders GJLH, Bangma CH (2007) How to screen for prostate cancer (PC) in men with low PSA (<3.0 ng/ml) – do we have to find all cancers? Eur Urol 6(Suppl): 174

    Google Scholar 

  19. Fisher B, Costantino JP, Wickerham DL et al. (1998) Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 90: 1371–1388

    Article  PubMed  CAS  Google Scholar 

  20. Marberger M, Adolfsson J, Borkowski A et al. (2003) The clinical implications of the prostate cancer prevention trial. BJU Int 92: 667–671

    Article  PubMed  CAS  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Referent für Fa. MSD, Sandoz, Studientätigkeit Fa. MSD. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Urologie, EuromedClinic, Europa-Allee 1, 90763, Fürth, Deutschland

    B.J. Schmitz-Dräger, E. Bismarck & H.J. Dörsam

  2. Urologische Klinik, Krankenhaus Hohe Warthe, Klinikum, Bayreuth, Deutschland

    C. Fischer

  3. Urologische Klinik, St. Josef Hospital, Troisdorf, Deutschland

    G. Lümmen

Authors
  1. B.J. Schmitz-Dräger
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  2. C. Fischer
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  3. E. Bismarck
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  4. H.J. Dörsam
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  5. G. Lümmen
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Correspondence to B.J. Schmitz-Dräger.

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Schmitz-Dräger, B., Fischer, C., Bismarck, E. et al. Das „Prostate Cancer Prevention Trial“ (PCPT). Urologe 46, 1364–1370 (2007). https://doi.org/10.1007/s00120-007-1553-9

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  • DOI: https://doi.org/10.1007/s00120-007-1553-9

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