Presented by: Ziv Savin MD
Tel Aviv Sourasky Medical Center

Introduction

5-alpha reductase inhibitors (5-ARI) change hormonal pathways and reduce prostate size. We evaluated the effects of 5-ARI on prostatic multiparametric magnetic resonance imaging (mpMRI) suspicious findings and identification of prostate cancer using mpMRI-targeted biopsies.

Materials

We conducted a retrospective study including 482 consecutive patients who underwent mpMRI-targeted biopsies between 2017-2021. Number of suspicious lesions, their Prostate Imaging Reporting & Data System version 2 (PIRADS v2) scores, and identification of clinically significant prostate cancer (CSPC), both overall and from regions of interest (targeted-CSPC), were compared between patients treated with 5-ARI for a minimum of 6 months on the time the MRI was performed and the others.

Results

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Patients treated with 5-ARI were older (p<0.001) with higher rates of previous prostate biopsies (p=0.03). Maximal PIRADS scores were 3, 4 and 5 in 9 (22%), 24 (58%) and 8 (20%) patients among 5-ARI patients, and 97 (22%), 251 (57%) and 93 (21%) patients among the others, and were not different between the groups (p=0.97, Table 1). The number of suspicious lesions per patient was also not different between the groups (p=0.8). Overall CSPC and targeted-CSPC identification rates among 5-ARI patients were 41% and 31%, respectively, and were not different compared to the others (p=0.39 and p=0.86, respectively). Rates of targeted-CSPC for each PIRADS score were not affected by 5-ARI treatment (Table 1). 5-ARI treatment was not associated with neither PIRADS5 score nor targeted-CSPC on logistic regression analyses (OR=0.9, 95%CI 0.4-2 and OR=1, 95%CI 0.5-2.1, respectively). Insignificant prostate cancer identification was higher among patients not treated with 5-ARI (p=0.01).

Conclusion

5-ARI treatment is not associated with number of lesions, PIRADS score alterations or targeted biopsy results. Patients treated with 5-ARI with suspicious lesions should not be addressed differently during the mpMRI-related diagnostic process.

Funding

None

Lead Authors

Snir Dekalo, MD
Tel Aviv Sourasky Medical Center

Co-Authors

Avishay Shem Tov Dlugy, MD
Tel Aviv Sourasky Medical Center

Haim Herzberg, MD
Tel Aviv Sourasky Medical Center

Yotam Veredgorn, MD
Tel Aviv Sourasky Medical Center

Roy Mano, MD
Tel Aviv Sourasky Medical Center

Yuval Bar-Yosef, MD
Tel Aviv Sourasky Medical Center

Ofer Yossepowitch, MD
Tel Aviv Sourasky Medical Center