Search

Background: To investigate if the PI-RADS score represents an effective tool in detecting prostate cancer in patients treated with a 5α-reductase inhibitor (dutasteride) and to identify dedicated total serum PSA and PSA density thresholds. Methods: Between April 2015 and March 2018, 75 patients under dutasteride treatment underwent multi-parametric magnetic resonance imaging (mpMRI) scans and US/MRI fusion prostate biopsy. Lesions were classified into two groups: Group 1 included PI-RADS 4 and 5 lesions, whilst Group 2 included PI-RADS 3-4-5 lesions. Lesions in groups 1 and 2 were further divided according to the patients’ history of previous prostate biopsy. Results: Ninety-seven lesions were detected. In PI-RADS 4-5 group, mpMRI showed a sensitivity of 78.0% and a specificity of 78.7%. The positive predictive value (PPV) was 79.6% and the negative predictive value (NPV) 77.1%. In PI-RADS 3-4-5 group, sensitivity was 100%, specificity 21.3%, PPV 57.5%, NPV 100%. In PI-RADS 4-5 biopsy-naive group sensitivity was 71.4%, specificity 75.0%. PPV 78.9% and NPV 66.7%. In PI-RADS 4-5 non-biopsy-naive group sensitivity was 82.8%, specificity 80.6%, PPV 80%, and NPV 83.3%. PI-RADS 3-4-5 biopsy-naive group showed sensitivity 100%, specificity 31.3%, PPV 65.6%, NPV 100%. PI-RADS 3-4-5 non-biopsy-naive group showed sensitivity 100%, specificity 16.1%, PPV 52.7%, and NPV 100%. ROC curve analysis indicated a serum total PSA threshold of 6 ng/ml (AUC: 0.71–95% confidence interval: 0.60–0.81) and a PSA density >0.22 (AUC: 0.70–95% confidence interval: 0.6–0.81) as optimal cut-offs for recommending prostate biopsy. Conclusions: In our experience the PI-RADS score proved to be sufficiently accurate in predicting prostate cancer in patients under dutasteride therapy.

19 patients suffering from symptomatic benign prostatic hyperplasia (BPH) underwent symptom score analysis, serum PSA level determination, trans-rectal ultrasound, flowmetry and pressure/flow (P/F) studies both before and at the end of a six month treatment period with finasteride, 5 mg a day. After six months of therapy, 89.5% of the pts had a significant symptomatic improvement, according to the decrease in symptom scores. Urodynamic evaluation showed a significant decrease in voiding pressure in 84% of the pts. 5 pts moved from the “obstructed” to the “unobstructed” section of the Abrams-Griffiths nomogram. 15/19 pts had a significant decrease in prostatic weight, as showed by means of ultrasound evaluation. This study confirms the efficacy of finasteride both in the symptomatic relief and in the functional improvement of BPH pts.