Thompson Ian M, Klein Eric A, Lippman Scott M, Coltman Charles A, Djavan Bob
University of Texas Health Science Center, Division of Urology, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA.
Eur Urol. 2003 Dec;44(6):650-5. doi: 10.1016/j.eururo.2003.11.001.
Prostate cancer is the most common male cancer, affecting one man in six. Prevention of this disease, even in a subset of patients would have a significant impact on public health. The results of the National Cancer Institute-sponsored Prostate Cancer Prevention Trial demonstrate that finasteride causes a substantial risk reduction across all known risk groups. We herein amplify on the results of this trial to assist patients and physicians in reaching individualized decisions.
The results of the Prostate Cancer Prevention Trial were reviewed.
The PCPT demonstrated a 24.8% reduction in prostate cancer risk with the administration of finasteride. High-grade cancers were noted in 6.4% of finasteride patients compared to 5.1% of men receiving placebo. The increase in high-grade tumors was seen within one year of finasteride exposure and did not increase over time. This observation, combined with previous evidence demonstrating an alteration in cytologic and architectural features of prostate cancer with hormonal therapy suggests that the differences in high-grade disease may be an artifact and that application of Gleason grading to these tumors may not be appropriate.
Men should be presented the benefits and risks of taking finasteride and be assisted in integrating their sexual and urinary symptoms into their decision-making process. Blanket statements for or against the use of this medication ignore patient preferences and differential risk-benefit profiles from finasteride.
前列腺癌是最常见的男性癌症，每六个男性中就有一人受其影响。预防这种疾病，即使仅针对一部分患者，也会对公众健康产生重大影响。美国国立癌症研究所资助的前列腺癌预防试验结果表明，非那雄胺能在所有已知风险组中显著降低风险。我们在此详述该试验结果，以帮助患者和医生做出个体化决策。
回顾前列腺癌预防试验的结果。
前列腺癌预防试验表明，服用非那雄胺可使前列腺癌风险降低24.8%。非那雄胺组患者中高级别癌症的发生率为6.4%，而接受安慰剂的男性中这一比例为5.1%。高级别肿瘤的增加在接触非那雄胺的一年内出现，且未随时间增加。这一观察结果，结合先前证据表明激素疗法会改变前列腺癌的细胞学和结构特征，提示高级别疾病的差异可能是一种假象，对这些肿瘤应用 Gleason 分级可能并不合适。
应向男性介绍服用非那雄胺的益处和风险，并帮助他们将性症状和泌尿症状纳入决策过程。支持或反对使用这种药物的一概而论的说法忽略了患者的偏好以及非那雄胺不同的风险效益情况。
