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The following is a summary of “Monitoring of prostate-specific antigen in men with benign prostate enlargement receiving 5-alpha reductase inhibitors: a non-interventional, cross-sectional study of real-world practice of urologists in Spain and Brazil,” published in the January 2025 issue of BMC Urology by Palacios et al. 

Inconsistent prostate-specific antigen monitoring in patients on 5-alpha reductase inhibitors may impact prostate cancer outcomes. 

Researchers conducted a retrospective study on real-world urology practices for patients receiving 5-alpha reductase inhibitors. 

They conducted a non-interventional, cross-sectional study collecting data from 100 urologists in Spain and 100 in Brazil using self-reporting questionnaires and patient record forms. Endpoints included prostate-specific antigen monitoring frequency/methodology, concerns about 5-alpha reductase inhibitors’ effects, biopsy triggers, and concerns when switching formulations. 

The results showed that over half of urologists monitored prostate-specific antigen every 6 months (Spain 59%, Brazil 58%). Preferred methods were the “doubling rule” (Spain 66%, Brazil 41%) and “increase from nadir” (Spain 28%, Brazil 43%). Few monitored unadjusted values (Spain 3%, Brazil 11%) or did not monitor at all (Spain 1%, Brazil 3%). Most ranked the potential for 5-alpha reductase inhibitors to mask prostate cancer as their top concern (Spain 65%, Brazil 56%). The most selected biopsy trigger was a doubled adjusted prostate-specific antigen level >4 ng/mL after 6 months (Spain 39%, Brazil 37%). Many were moderately/very concerned about prostate-specific antigen changes when switching formulations. 

Investigators identified a need for standard guidance and continuous education to improve prostate-specific antigen monitoring and interpretation in patients treated with 5-alpha reductase inhibitors. 

Source: bmcurol.biomedcentral.com/articles/10.1186/s12894-025-01701-1