Prostate Cancer Survivors






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Avodart affect on biopsy tissue Gleason score ?

I was reading a contributor story and the subject of Proscar and Flomax and Gleason score came up. Quoting from

How does 4 years on Proscar and Flomax affect the appearance of biopsy sample slides under the microscope? [Unequivocally "Yes", according to Dr Gleason, after whom the Gleason grading system is named, and other experts.]

Is use of Proscar and Flomax likely to make perceived Gleason scores higher or lower? [Dr Gleason says that the current grading system cannot be applied to samples from glands where finasteride has been administered.]

Does the pathologist have to be advised in advance to make allowances for this? [Yes]

My situation , which I have not yet posted at this site, 52 year old long time user of Avodart, I recently had a 12 core TRUS biopsy with one core positive at 4 + 3 for cancer (40%) . 10 cores were benign, one other had 'PIN'. I doubt the pathologist was aware of my Avodart usage, it was NOT noted in the pathology report, which I have.
I Googled allowances for these medicines on the Gleason score and only found general information, not directly speaking to the Pathologist scoring of the tissue itself.
Thanks for the help on this.

Re: Avodart affect on biopsy tissue Gleason score ?

You should note that Dr. Gleason has been dead for 7 years and was probably past his best years 10 years before that.

From my understanding of pathology the cancer cells will be what they are and a Gleason Score can be estimated/determined/guessed by the pathologist. Whether you have been taking a hormone affecting drug is not something of importance to the pathologist but might be important to your oncologist.

Since you already have a small amount of 4 & 3 you should probably go on very active surveillance for a few months to see how your PSA reacts if you go off the Avodart. My understanding is the Flomax should not affect PSA readings one way or the other.

Hope this helps a bit.

Re: Avodart affect on biopsy tissue Gleason score ?

My PSA numbers.... my high was 4.4 , I upped my Avodart use from around 1 in 5 days to everyday, and the PSA went down to 3.3 around 5 months later, right before I got a biopsy with a Gleason 7. I keep being surprised with my test results. I am currently planning on a laser ablation procedure in a couple months, also had an mpMRI positive area for cancer. My Urologist says a RP would be his choice, I have read too many side affects, I couldn't do my job with some of them.
The other thing I'm doing is taking every Prostate supplement I can buy and changing diet , little meat/dairy etc, and that may have an influence with my PSA numbers.

Re: Avodart affect on biopsy tissue Gleason score ?

It has been a while since I was taking Avodart, but back then I took an interest in the effects of Avodart on various factors, including PSA and Gleason grading. Looking back over my notes, I came across this :

There were two different clinical trials (the Prostate Cancer Prevention Trial and the REDUCE trial) that identified a lower rate of positive biopsies for those treated with one of the 5 alpha-reductase inhibitors. These inhibitors are dutasteride (Avodart) and finasteride (Flomax), Quoting from the REDUCE Study Group “the major effect of dutasteride is the shrinkage of prostate tumors or inhibition of their growth”.

However, both trials did show a higher number of higher grade cancers, especially in later years of the trials. There are many researchers who believe that the incidence of higher grade cancers is due to one or a combination of factors including biopsy sampling density bias, grading bias and the effect of more men in the placebo groups leaving the trials with their higher rate of diagnosed cancer. As for grading bias, quoting Civantos et al “finasteride may induce some foci of lower grade cancer to resemble higher grade cancer" and David G Bostwick states “finasteride treatment is likely to overestimate the biologic potential of high grade cancer”.

So if you believe those two gentlemen (Civantos and Bostwick) there is a change in the pathology of cancer cells that makes lower grade cancers look more like higher grade cancers and thereby affect Gleason grading.

Re: Avodart affect on biopsy tissue Gleason score ?

Brian I find very interesting the statement that “finasteride may induce some foci of lower grade cancer to resemble higher grade cancer." Really?
About 6 years ago I was diagnosed with a small amount of GS 6 PCa. I decided to go on A.S. with PSA tests every 3 months. My uro supported my A.S. but he seemed more concerned about my PSA velocity which he felt was greater than it should be for the small amount of cancer I seemed to have (2 cores each <5%). He put me on finasteride. It did slow the increase in PSA, but it did not stop it. I took it for about 18 months but stopped because I felt that the finasteride might be masking the "real" PSA level. My next biopsy showed I now appeared to have GS 8 PCa. Are you saying there exists the possibility that my GS 8 cancer might not have been "real" GS 8, but only GS 6 made to "resemble" GS 8?

Re: Avodart affect on biopsy tissue Gleason score ?

Joe, you can find the statement "finasteride may induce some foci of lower grade cancer to resemble higher grade cancer" in the paper:

The whole paper is long but interesting. For the quote, scroll down to paragraph 3 of the Discussion, where reference 21 is shown.

Re: Avodart affect on biopsy tissue Gleason score ?

Thanks for the replies, who is the individual replying in the original quote I copied?

Re: Avodart affect on biopsy tissue Gleason score ?

Maybe you should take your doctor's advice and get cured while you are young. A good surgeon in combination with your youth should mitigate the side effects: a stitch in time...