What medications decrease Prostate-Specific Antigen (PSA) levels?

From the Guidelines

Dutasteride is the most effective medication for decreasing PSA levels, with a median decrease of 59.5% at 2 years and 66.1% at 4 years, as shown in a study published in The Journal of Urology 1. When interpreting PSA test results for prostate cancer screening, it is essential to consider the effects of various medications on PSA levels. 5-alpha reductase inhibitors, such as finasteride and dutasteride, can reduce PSA levels by approximately 50% after 6-12 months of treatment, according to a study published in the Journal of the National Comprehensive Cancer Network 1. These medications work by blocking the conversion of testosterone to dihydrotestosterone, reducing prostate size and PSA production. Other medications that may lower PSA include statins and non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, which may slightly decrease PSA levels through their anti-inflammatory effects. Testosterone-lowering medications used in prostate cancer treatment also significantly reduce PSA levels. It's crucial for healthcare providers to be aware of these medication effects when monitoring PSA levels, as they can mask potential prostate cancer. For patients on 5-alpha reductase inhibitors, PSA values should typically be doubled for proper interpretation, and baseline PSA measurements should be obtained before starting these medications whenever possible, as recommended by the NCCN clinical practice guidelines for prostate cancer early detection 1. Key points to consider when evaluating the effect of medications on PSA levels include:

• The type and dose of medication
• The duration of treatment
• The individual patient's response to treatment
• The potential for medication interactions
• The importance of regular monitoring and follow-up to ensure accurate interpretation of PSA test results. In clinical practice, the most recent and highest quality study should be prioritized when making decisions about medication use and PSA interpretation, such as the study published in The Journal of Urology in 2006 1.

From the FDA Drug Label

In clinical studies, finasteride tablets reduced serum PSA concentration by approximately 50% within six months of treatment. Dutasteride capsules reduces serum PSA levels by approximately 50% within 3 to 6 months of therapy, although it may vary for each individual

Medications that decrease PSA:

• Finasteride (PO) 2
• Dutasteride (PO) 3

These medications decrease PSA levels by approximately 50% within 3 to 6 months of therapy.

From the Research

Medications that Decrease PSA

• Finasteride: a 5-alpha-reductase inhibitor that has been shown to reduce prostate size and decrease serum levels of prostate-specific antigen (PSA) 4
• Dutasteride: a dual inhibitor of 5-alpha-reductase that inhibits both types 1 and 2 isozymes of 5-alpha-reductase, reducing the risk of acute urinary retention and the need for benign prostatic hyperplasia-related surgical intervention, and decreasing prostate volume 5

Effects on PSA Levels

• Finasteride: decreases PSA levels by a median of 50% after 12 months of treatment 4
• Dutasteride: decreases PSA levels, although the exact percentage decrease is not specified in the available evidence 5
• 5-ARIs: decrease PSA levels by a mean of 47% during treatment 6

Clinical Implications

• Physicians using finasteride or dutasteride should be aware of their effect on PSA levels, as this may impact the interpretation of PSA results 4, 6
• The reduction in PSA levels with 5-ARIs does not appear to confer any therapeutic benefit in terms of preventing prostate cancer or delaying its progression 6