Health and Prostate

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When men over age 50 have their annual check-ups, the doctor often checks blood levels of prostate-specific antigen (PSA) to screen for prostate cancer. A new study suggests that PSA levels may also predict prostate growth in men with benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.

The Proscar Long-Term Efficacy and Safety Study enrolled more than 3,000 men over age 50 with a diagnosis of BPH and randomized them to receive either finasteride (Proscar) or placebo for four years. Participants came from 95 centers; at 13 of these centers, 10 percent of the men had MRIs to measure their prostate volume when the study began and each year after. In the current report, the researchers looked at information from the men who’d taken placebo to see what baseline measurements predict growth of the prostate.

The size of a man’s prostate is a good indicator of problems to come. For example, the larger a man’s prostate, the more likely it is that he will have an acute urinary retention problem. Men with large prostates also are less likely to respond to drug treatment and more likely to need prostate surgery.

Based on data from 164 patients, the researchers found that the prostate continued to grow steadily over the four years of the study, and the older a man, the more his prostate grew each year. Prostate-specific antigen levels also tended to rise with age.

What predicted prostate growth the best, however, was the amount of PSA in the blood when the study began. Almost one-third of the men with PSA levels less than 2.0 ng/ml had a decrease in their prostate size over the four years, compared to just one of those with a PSA level of more than 2.0 ng/ml.

Since men with large prostates are more likely to have problems, having a way to predict prostate growth would help doctors. And since many doctors use prostate-specific antigen tests to screen for prostate cancer anyway, they should be able to use the results to help manage prostate growth too.

Writing in the January issue of The Journal of Urology, the researchers explain that this simple idea may be harder to get across than you’d think. In the past, prostate size was considered unimportant, and doctors focused on treating urinary symptoms. Now that research has shown that PSA and prostate size do predict adverse outcomes, doctors will need to change their approach to thinking about management and future risk rather than just symptoms.

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