Rapid CommunicationsSerum prostate-specific antigen concentration is a powerful predictor of acute urinary retention and need for surgery in men with clinical benign prostatic hyperplasia1
Section snippets
Subjects
Three thousand forty men with clinical BPH diagnosed on the basis of moderate-to-severe symptoms, a decreased peak urinary flow rate (less than 15 mL/s with a voided volume of 150 mL or more; Urodyn 1000, Dantec, Mahway, NJ), and an enlarged prostate gland by DRE were enrolled in a 4-year study comparing finasteride with placebo. Men receiving alpha-blocking agents or antiandrogens and men with a history of chronic prostatitis, recurrent urinary tract infections, prostate or bladder cancer or
Results
At baseline, men assigned to finasteride and placebo were similar in terms of age, demographics, symptom severity, peak flow rate, prostate volume, and serum PSA (Table I).
Baseline characteristics of the subset with prostate volume measurements were similar to those in the entire study group.
The overall incidence of AUR was 7% with placebo and 4% with finasteride (spontaneous AUR 4% with placebo and 1% with finasteride; precipitated AUR 3% with placebo and 2% with finasteride) and of
Comment
Serum PSA is currently the most widely used marker for prostate cancer detection, and a yearly measurement is recommended in men older than 50 years to aid in the early detection of prostate cancer. The observation that there is a strong log-linear relationship between serum PSA and prostate volume in men with BPH10 has led us to consider that PSA may also predict those men at increased risk of developing AUR or needing BPH-related surgery.
In the longitudinal community-based Olmsted County
Conclusions
Serum PSA strongly correlates with prostate volume in men with BPH, and both parameters predict equally well the risk of AUR and the need for BPH-related surgery. The incidence of both untoward outcomes increases nearly linearly with increasing serum PSA and prostate volume in men treated with placebo—or watched conservatively—and it is reduced by 50% or more in men on finasteride independent of baseline serum PSA and prostate volume. The predictable risk of retention and need for surgery, and
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- 2
Dr. Waldstreicher and Thomas J. Cook are employees of Merck & Co., Inc., the sponsor of the study.