Faculty Bibliography

PURPOSE OF REVIEW: To determine whether alpha-blockers, commonly used for the treatment of benign prostatic hyperplasia, are associated with prostate cancer risk. RECENT FINDINGS: Alpha-blockers have been associated with a reduced risk of prostate cancer aggressiveness in some observational studies and an increased risk in other studies. However, this relationship is complex as different alpha-blockers have divergent effects in laboratory studies and there are many confounders in daily practice such as differential screening practices. SUMMARY: Both benign prostatic hyperplasia and prostate cancer are common conditions in the aging male population, such that an interaction between alpha-blockers and prostate cancer risk is clinically relevant. Prospective evidence is necessary to establish a definitive link.

Screening and treatment of prostate cancer remain controversial, particularly for elderly men. Since the previous United States Preventive Services Task Force recommendation in 2008 against prostate-specific antigen (PSA) screening after age 75 years, there has not been a substantial reduction in the frequency of PSA testing in this age group. A substantial proportion of elderly men are overdiagnosed and overtreated. On the other hand, men aged >75 years have more aggressive disease. Although screening has questionable benefit for elderly men with significant comorbidities, healthy men >75 years may benefit from definitive therapy. This review discusses prostate cancer screening and management decisions for elderly men, including the use of nomograms and predictive tools for life expectancy. 2013 Springer Science+Business Media New York (outside the USA)