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• W2067961971 abstract "No AccessJournal of UrologyAdult urology1 Mar 2006Do the Benefits of Finasteride Outweigh the Risks in the Prostate Cancer Prevention Trial? Steven Grover, Ilka Lowensteyn, David Hajek, John Trachtenberg, Louis Coupal, and Sylvie Marchand Steven GroverSteven Grover Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada Departments of Medicine and Epidemiology & Biostatistics, McGill University, Montreal, Quebec More articles by this author , Ilka LowensteynIlka Lowensteyn Departments of Medicine and Epidemiology & Biostatistics, McGill University, Montreal, Quebec Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author , David HajekDavid Hajek Department of Surgical Oncology/Urology, The Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author , John TrachtenbergJohn Trachtenberg Department of Surgical Oncology/Urology, The Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author , Louis CoupalLouis Coupal Departments of Medicine and Epidemiology & Biostatistics, McGill University, Montreal, Quebec Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author , and Sylvie MarchandSylvie Marchand Departments of Medicine and Epidemiology & Biostatistics, McGill University, Montreal, Quebec Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)00424-6AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: The Prostate Cancer Prevention Trial demonstrated that finasteride could reduce the incidence of prostate cancer by 25%. However, its use was also associated with an increased risk of high grade cancer resulting in uncertainty surrounding the net benefits of therapy. Materials and Methods: We used the Montreal Prostate Cancer Model, a validated Markov model of prostate cancer progression, to compare the forecasted survival in treated and untreated men. The conditions of the model were varied to reflect different assumptions about whether the cancer grade difference observed in the PCPT was real or a treatment associated artifact, and whether cancers detected on end of study biopsies were clinically significant. Results: For a hypothetical cohort of 1,000, 62-year-old men treated with finasteride, an increased survival of 140 life-years (0.14 years per individual) is forecasted if all diagnosed cancers are considered. If tumor grade differences are held to be artifactual, the forecasted benefits increase to 200 life-years. However, if the tumor grade difference is real and only clinically detected cancers are considered, estimated increased survival is only 20 life-years (0.02 years per individual). Conclusions: The primary prevention of prostate cancer with finasteride looks promising. However, at the present time it should only be considered with caution until we have answered critical questions surrounding the difference in cancer grade observed in the PCPT and the clinical significance of cancers detected on protocol directed end of study biopsies. References 1 : Annual report to the nation on the status of cancer, 1975–2001, with a special feature regarding survival. Cancer2004; 101: 3. Google Scholar 2 U. S. Department of Health and Human Services, National Institutes of Health. 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Google Scholar © 2006 by American Urological AssociationFiguresReferencesRelatedDetailsCited byTaneja S (2013) Re: Long-Term Survival of Participants in the Prostate Cancer Prevention TrialJournal of Urology, VOL. 191, NO. 2, (358-361), Online publication date: 1-Feb-2014. Volume 175Issue 3March 2006Page: 934-938 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsrisk assessmentfinasterideprostatic neoplasmsprevention and controlMetricsAuthor Information Steven Grover Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada Departments of Medicine and Epidemiology & Biostatistics, McGill University, Montreal, Quebec More articles by this author Ilka Lowensteyn Departments of Medicine and Epidemiology & Biostatistics, McGill University, Montreal, Quebec Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author David Hajek Department of Surgical Oncology/Urology, The Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author John Trachtenberg Department of Surgical Oncology/Urology, The Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author Louis Coupal Departments of Medicine and Epidemiology & Biostatistics, McGill University, Montreal, Quebec Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author Sylvie Marchand Departments of Medicine and Epidemiology & Biostatistics, McGill University, Montreal, Quebec Centre for the Analysis of Cost-Effective Care, The Montreal General Hospital, Montreal, Quebec Divisions of General Internal Medicine and Clinical Epidemiology, The Montreal General Hospital, Montreal, Quebec Department of Surgery/Urology, University of Toronto, Toronto, Ontario, Canada More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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