Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate

Results of a four-year, randomized trial comparing finasteride versus placebo

Claus G. Roehrborn, Peter Boyle, Donald Bergner, Todd Gray, Marc Gittelman, Thomas Shown, Arnold Melman, R. Bruce Bracken, Ralph W deVere White, Alice Taylor, Daniel Wang, Joanne Waldstreicher

Research output: Contribution to journalArticle

169 Citations (Scopus)

Abstract

Objectives. To determine whether baseline prostate-specific antigen (PSA), in addition to prostate volume, is associated with long-term changes in symptoms and urinary flow rate. Methods. Three thousand forty men with benign prostatic hyperplasia enrolled in the PLESS trial were randomly assigned to finasteride 5 mg or placebo for 4 years. Symptoms and flow rate were assessed every 4 months, and data were analyzed by dividing the patients into three groups by baseline PSA tertiles (0 to 1.3, 1.4 to 3.2, and 3.3 ng/mL or greater) and baseline prostate volume tertiles (14 to 41, 42 to 57, and 58 to 150 mL). Results. After the initial placebo effect, a slow deterioration in symptoms over time was observed in the placebo-treated men with a baseline PSA 1.4 ng/mL or greater. However, placebo-treated men in the lowest PSA tertile (less than 1.4 ng/mL) had sustained symptomatic improvement that was not seen in placebo-treated men in the higher tertiles (P <0.001). In all finasteride-treated groups, there was initial improvement followed by maintenance or continued symptom improvement over time (~3 to 3.5 points by the end of 4 years). The differences in symptom score improvement between placebo and finasteride were marginal for men with baseline PSA levels less than 1.4 ng/mL (P = 0.128) but were highly significant for men with PSA levels 1.4 ng/mL or greater (P <0.001). Urinary flow rate results were similar to those observed for symptoms. Analysis of symptom and flow rate data by prostate volume tertiles in a 10% subset of men yielded similar results, namely a deterioration of symptoms and flow rate in the two higher tertiles treated with placebo (greater than 41 mL) and a sustained improvement in all three groups of finasteride-treated patients. Conclusions. Baseline PSA and prostate volume are good predictors of long- term symptomatic and flow rate changes. Baseline PSA levels of 1.4 ng/mL or greater and enlarged prostate glands predict the best long-term response to finasteride compared with placebo.

Original languageEnglish (US)
Pages (from-to)662-669
Number of pages8
JournalUrology
Volume54
Issue number4
DOIs
StatePublished - Oct 1999
Externally publishedYes

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Finasteride
Prostate-Specific Antigen
Prostate
Placebos
Serum
Placebo Effect
Prostatic Hyperplasia
Maintenance

ASJC Scopus subject areas

  • Urology

Cite this

Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate : Results of a four-year, randomized trial comparing finasteride versus placebo. / Roehrborn, Claus G.; Boyle, Peter; Bergner, Donald; Gray, Todd; Gittelman, Marc; Shown, Thomas; Melman, Arnold; Bracken, R. Bruce; deVere White, Ralph W; Taylor, Alice; Wang, Daniel; Waldstreicher, Joanne.

In: Urology, Vol. 54, No. 4, 10.1999, p. 662-669.

Research output: Contribution to journalArticle

Roehrborn, CG, Boyle, P, Bergner, D, Gray, T, Gittelman, M, Shown, T, Melman, A, Bracken, RB, deVere White, RW, Taylor, A, Wang, D & Waldstreicher, J 1999, 'Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate: Results of a four-year, randomized trial comparing finasteride versus placebo', Urology, vol. 54, no. 4, pp. 662-669. https://doi.org/10.1016/S0090-4295(99)00232-0
Roehrborn, Claus G. ; Boyle, Peter ; Bergner, Donald ; Gray, Todd ; Gittelman, Marc ; Shown, Thomas ; Melman, Arnold ; Bracken, R. Bruce ; deVere White, Ralph W ; Taylor, Alice ; Wang, Daniel ; Waldstreicher, Joanne. / Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate : Results of a four-year, randomized trial comparing finasteride versus placebo. In: Urology. 1999 ; Vol. 54, No. 4. pp. 662-669.
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abstract = "Objectives. To determine whether baseline prostate-specific antigen (PSA), in addition to prostate volume, is associated with long-term changes in symptoms and urinary flow rate. Methods. Three thousand forty men with benign prostatic hyperplasia enrolled in the PLESS trial were randomly assigned to finasteride 5 mg or placebo for 4 years. Symptoms and flow rate were assessed every 4 months, and data were analyzed by dividing the patients into three groups by baseline PSA tertiles (0 to 1.3, 1.4 to 3.2, and 3.3 ng/mL or greater) and baseline prostate volume tertiles (14 to 41, 42 to 57, and 58 to 150 mL). Results. After the initial placebo effect, a slow deterioration in symptoms over time was observed in the placebo-treated men with a baseline PSA 1.4 ng/mL or greater. However, placebo-treated men in the lowest PSA tertile (less than 1.4 ng/mL) had sustained symptomatic improvement that was not seen in placebo-treated men in the higher tertiles (P <0.001). In all finasteride-treated groups, there was initial improvement followed by maintenance or continued symptom improvement over time (~3 to 3.5 points by the end of 4 years). The differences in symptom score improvement between placebo and finasteride were marginal for men with baseline PSA levels less than 1.4 ng/mL (P = 0.128) but were highly significant for men with PSA levels 1.4 ng/mL or greater (P <0.001). Urinary flow rate results were similar to those observed for symptoms. Analysis of symptom and flow rate data by prostate volume tertiles in a 10{\%} subset of men yielded similar results, namely a deterioration of symptoms and flow rate in the two higher tertiles treated with placebo (greater than 41 mL) and a sustained improvement in all three groups of finasteride-treated patients. Conclusions. Baseline PSA and prostate volume are good predictors of long- term symptomatic and flow rate changes. Baseline PSA levels of 1.4 ng/mL or greater and enlarged prostate glands predict the best long-term response to finasteride compared with placebo.",
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T1 - Serum prostate-specific antigen and prostate volume predict long-term changes in symptoms and flow rate

T2 - Results of a four-year, randomized trial comparing finasteride versus placebo

AU - Roehrborn, Claus G.

AU - Boyle, Peter

AU - Bergner, Donald

AU - Gray, Todd

AU - Gittelman, Marc

AU - Shown, Thomas

AU - Melman, Arnold

AU - Bracken, R. Bruce

AU - deVere White, Ralph W

AU - Taylor, Alice

AU - Wang, Daniel

AU - Waldstreicher, Joanne

PY - 1999/10

Y1 - 1999/10

N2 - Objectives. To determine whether baseline prostate-specific antigen (PSA), in addition to prostate volume, is associated with long-term changes in symptoms and urinary flow rate. Methods. Three thousand forty men with benign prostatic hyperplasia enrolled in the PLESS trial were randomly assigned to finasteride 5 mg or placebo for 4 years. Symptoms and flow rate were assessed every 4 months, and data were analyzed by dividing the patients into three groups by baseline PSA tertiles (0 to 1.3, 1.4 to 3.2, and 3.3 ng/mL or greater) and baseline prostate volume tertiles (14 to 41, 42 to 57, and 58 to 150 mL). Results. After the initial placebo effect, a slow deterioration in symptoms over time was observed in the placebo-treated men with a baseline PSA 1.4 ng/mL or greater. However, placebo-treated men in the lowest PSA tertile (less than 1.4 ng/mL) had sustained symptomatic improvement that was not seen in placebo-treated men in the higher tertiles (P <0.001). In all finasteride-treated groups, there was initial improvement followed by maintenance or continued symptom improvement over time (~3 to 3.5 points by the end of 4 years). The differences in symptom score improvement between placebo and finasteride were marginal for men with baseline PSA levels less than 1.4 ng/mL (P = 0.128) but were highly significant for men with PSA levels 1.4 ng/mL or greater (P <0.001). Urinary flow rate results were similar to those observed for symptoms. Analysis of symptom and flow rate data by prostate volume tertiles in a 10% subset of men yielded similar results, namely a deterioration of symptoms and flow rate in the two higher tertiles treated with placebo (greater than 41 mL) and a sustained improvement in all three groups of finasteride-treated patients. Conclusions. Baseline PSA and prostate volume are good predictors of long- term symptomatic and flow rate changes. Baseline PSA levels of 1.4 ng/mL or greater and enlarged prostate glands predict the best long-term response to finasteride compared with placebo.

AB - Objectives. To determine whether baseline prostate-specific antigen (PSA), in addition to prostate volume, is associated with long-term changes in symptoms and urinary flow rate. Methods. Three thousand forty men with benign prostatic hyperplasia enrolled in the PLESS trial were randomly assigned to finasteride 5 mg or placebo for 4 years. Symptoms and flow rate were assessed every 4 months, and data were analyzed by dividing the patients into three groups by baseline PSA tertiles (0 to 1.3, 1.4 to 3.2, and 3.3 ng/mL or greater) and baseline prostate volume tertiles (14 to 41, 42 to 57, and 58 to 150 mL). Results. After the initial placebo effect, a slow deterioration in symptoms over time was observed in the placebo-treated men with a baseline PSA 1.4 ng/mL or greater. However, placebo-treated men in the lowest PSA tertile (less than 1.4 ng/mL) had sustained symptomatic improvement that was not seen in placebo-treated men in the higher tertiles (P <0.001). In all finasteride-treated groups, there was initial improvement followed by maintenance or continued symptom improvement over time (~3 to 3.5 points by the end of 4 years). The differences in symptom score improvement between placebo and finasteride were marginal for men with baseline PSA levels less than 1.4 ng/mL (P = 0.128) but were highly significant for men with PSA levels 1.4 ng/mL or greater (P <0.001). Urinary flow rate results were similar to those observed for symptoms. Analysis of symptom and flow rate data by prostate volume tertiles in a 10% subset of men yielded similar results, namely a deterioration of symptoms and flow rate in the two higher tertiles treated with placebo (greater than 41 mL) and a sustained improvement in all three groups of finasteride-treated patients. Conclusions. Baseline PSA and prostate volume are good predictors of long- term symptomatic and flow rate changes. Baseline PSA levels of 1.4 ng/mL or greater and enlarged prostate glands predict the best long-term response to finasteride compared with placebo.

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