Continuing Education Program #08CE059d • RELEASE DATE: November 15, 2008 • EXPIRATION DATE: November 14, 2009
Finasteride and Prostate Cancer Prevention: The Latest Chapter
EDITORIAL BOARD Amy K. Darke, MS Public Health Services Division Fred Hutchinson Cancer Research Center Seattle, WA 98109
BY MARY W. REDMAN PHD Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
Helen McFarland, PharmD, BCOP Clinical Pharmacist—Oncology and Pain Management Department of Pharmacy Union Memorial Hospital Baltimore, MD 21218
HOW TO RECEIVE NURSING CREDIT To receive continuing education credit, learners must: • Read the article in its entirety • Take the CE self-assessment test and complete the evaluation test: 1. Log onto www.theoncologynurse.com. 2. Click on UNMC logo on homepage. 3. Register to participate. 4. Enter program number #08CE059d. • Complete and submit the evaluation form online (enter program number #08CE059d). Nurses must answer at least 70% of the questions on the post-test correctly. If Internet access is not available, please fax a request for an evaluation form to 402-559-6379, attn: Anji Wittman, (please include return fax number) or e-mail email@example.com • The estimated time to complete this activity is 1 hour. Your continuing education certificate can be printed by following the directions online after successful completion of the post-test. DISCLAIMERS The opinions or views expressed in this continuing education activity are those of the faculty and do not necessarily reflect the opinions or recommendations of the University of Nebraska Medical Center College of Nursing Continuing Nursing Education. While the University of Nebraska Medical Center College of Nursing Continuing
ur recently published reanalysis of the Prostate Cancer Prevention Trial (PCPT) appears to settle the issue of finasteride’s role in prostate cancer prevention. My colleagues and I reported that the 5-alpha-reductase inhibitor reduced risk of prostate cancer detection by 30% in healthy men >55 years of age without the increased rate of detecting high-grade tumors (Gleason grade >7) seen in the initial study.1,2 An accompanying editorial supports our findings, stating that “finasteride is a safe and effective prevention option that should be offered to men at risk for prostate cancer.”3 Increased detection of high-grade malignancies in the initial study appeared to primarily reflect improved screening properties of prostate-specific antigen (PSA) testing and digital rectal examination (DRE) as well as an increased sensitivity for detecting such tumors on biopsy in men receiving finasteride rather than any effect of finasteride on the biology of cancer progression.1 The increased biopsy sensitivity most likely resulted from the prostate gland shrinkage associated with finasteride, in line with its approved use in benign prostatic hypertrophy.1,4 FACULTY/PLANNER DISCLOSURES All planners and faculty participating in continuing education activities provided by the University of Nebraska Medical Center, College of Nursing Continuing Nursing Education are expected to disclose to the audience any significant support or substantial relationship(s) with providers of commercial products and/or devices discussed in this activity and/or with any commercial supporters of the activity. In addition, all faculty are expected to openly disclose any off-label, experimental, or investigational use of drugs or devices discussed in their presentation. The planners and faculty and have been advised that this activity must be free from commercial bias and based upon all the available scientifically rigorous data from research that conforms to accepted standards of experimental design, data collection, and analysis.
Nursing Education is an ANCC accredited organization, this does not imply endorsement by the UNMC or ANCC of any commercial products affiliated with this activity. PROGRAM GOAL To educate oncology nurses about recent findings about the potential role of finasteride in prostate cancer prevention. LEARNING OBJECTIVES After completing this activity, the reader should be better able to: • Summarize the initial findings of the Prostate Cancer Prevention Trial. • Explain how finasteride may affect prostate cancer detection by prostate-specific antigen testing or digital rectal examination. • Discuss how the use of a risk calculator may be helpful for patients and their physicians when evaluating prostate cancer risk and making decisions about prevention. TARGET AUDIENCE Advanced practice nurses, registered nurses, and other interested healthcare professionals, especially those caring for cancer patients. COST This program is complimentary for all learners.
Initial PCPT findings We first studied finasteride as a possible protective agent because it blocks conversion of testosterone to the more potent androgen dihydrotestosterone involved in prostate cancer development. The large (N = 18,882), National Cancer Institute–funded PCPT followed lowrisk men >55 years of age treated with placebo or finasteride (5 mg daily) for 7 years to determine the drug’s effect on prostate cancer detection.2 Men underwent annual PSA testing and DRE. Those with abnormal DRE or annual PSA >4 ng/mL, adjusted for finasteride’s effect, were referred for biopsy. This analysis revealed that: • Finasteride reduced the risk of prostate cancer detection by 24.8% overall (detection rates, 18.4% in the finasteride group vs 24.4% in the placebo group, 95% confidence interval [CI], 18.6% to 30.6%, P <.001) • Finasteride was associated with a higher risk of detecting highgrade malignancy. Gleason grade >7 tumors were identified in 6.4% of men in the finasteride group compared with 5.1% of men in the placebo group, for a 27% higher risk (95% CI, 1.07 to 1.50, P = .005).
The following authors, reviewers, and planning committee members listed below have stated they have no significant or substantial relationship with providers of commercial products and/or devices discussed in this activity and/or with any commercial supporter of this activity. • Lisa Anzai, RN, MA • Catherine Bevil, RN, EdD • Jennifer Ludwig, PharmD • Lara J. Reiman • Karen Rosenberg • Gary C. Yee, PharmD, FCCP, BCOP • Amy K. Darke, MS • Helen McFarland, PharmD, BCOP • Mary W. Redman, PhD • Gary Shelton, MSN, ARNP, AOCN
The following author has stated that he has the following financial relationships: Ian M. Thompson, MD, states that he is a consultant for Veridex and Mission. CONTINUING NURSING EDUCATION ACCREDITATION AND CONTACT HOURS STATEMENT The University of Nebraska Medical Center College of Nursing Continuing Nursing Education is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. This activity is provided for 1.0 contact hours under ANCC criteria. Provided for 1.2 contact hours under Iowa Provider #78. Provider Approved by the California Board of Registered Nursing, Provider #13699 for 1.2 contact hours.
Mary W. Redman, PhD Public Health Services Division Fred Hutchinson Cancer Research Center Seattle, WA 98109 Gary Shelton, MSN, ARNP, AOCN Clinical Research Program NYU Cancer Institute New York, NY 10016 Ian M. Thompson, MD Department of Urology The University of Texas Health Science Center at San Antonio San Antonio, TX 78229 PLANNING COMMITTEE Lisa Anzai, RN, MA Nurse Planner University of Nebraska Medical Center College of Nursing 985330 Nebraska Medical Center Omaha, Nebraska 68198-5330 Catherine Bevil, RN EdD Director, Continuing Nursing Education and Evaluation University of Nebraska Medical Center College of Nursing 985330 Nebraska Medical Center Omaha, Nebraska 68198-5330 Lara J. Reiman Managing Editor Green Hill Healthcare Communications, LLC 241 Forsgate Drive Monroe Twp, NJ 08831 Karen Rosenberg Editorial Director Green Hill Healthcare Communications, LLC 241 Forsgate Drive Monroe Twp, NJ 08831 REVIEWERS Jennifer Ludwig, pharmD Oncology Pharmacist University of Nebraska Medical Center Omaha, NE 68198 Gary C. Yee, PharmD, FCCP, BCOP Professor of Pharmacy Practice Associate Dean for Academic Affairs College of Pharmacy University of Nebraska Medical Center Omaha, NE 68198
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