RATIONALE: Diagnostic procedures, such as MRI and magnetic resonance spectroscopy imaging, may help in learning how well dutasteride works in patients with benign prostatic hypertrophy and low-risk prostate cancer.

PURPOSE: This clinical trial is studying MRI and magnetic resonance spectroscopy imaging in patients receiving dutasteride for benign prostatic hypertrophy and low-risk prostate cancer.

OBJECTIVES:

Primary

• To determine whether there is a decrease in the extent of prostate cancer as measured by endorectal MRI and magnetic resonance spectroscopy imaging in patients with symptomatic benign prostatic hypertrophy and low-risk prostate cancer treated with dutasteride for 6 months.

Secondary

• To monitor the effects of dutasteride on serum testosterone, dihydrotestosterone, and free and total prostate-specific antigen (PSA).
• To monitor the effects of dutasteride on symptom and quality-of-life indices.

OUTLINE: Patients receive oral dutasteride once daily for 6 months.

Patients undergo endorectal MRI and magnetic resonance spectroscopy imaging at baseline and at 1, 3, and 6 months.

Patients complete quality-of-life questionnaires using the International Index of Erectile Function Questionnaire, American Urological Association Symptom Index, Functional Alterations due to Changes in Elimination, and Spitzer Quality-of-Life Index at baseline and at 1, 3, and 6 months.

Inclusion criteria:

• Histologically confirmed adenocarcinoma of the prostate

  • Clinical stage T1b, T1c, or T2a disease
  • Gleason score ≤ 6
  • Maximal prostate-specific antigen (PSA) < 10 ng/mL

• Demonstrates intra-prostatic metabolite abnormalities, consistent with adenocarcinoma of the prostate (i.e., ≥ 3 voxels with magnetic resonance spectroscopy imaging [MRSI] scores 4-5) by baseline MRI and MRSI

• Has symptomatic benign prostatic hypertrophy and is currently undergoing watchful waiting OR opting to undergo permanent seed implant (i.e., brachytherapy), but requires neoadjuvant androgen suppression for prostate shrinkage

• No regional lymph node involvement

• No evidence of distant metastases

• Zubrod performance status 0-1

• Able to swallow and retain oral medications

Exclusion Criteria:

• Other prior or concurrent invasive cancer, other than localized basal cell or squamous cell carcinoma of the skin

• Contraindications to MRI/MRSI, including any of the following:

  • Prostate biopsy (within the past 8 weeks) and any continued post-biopsy bleeding
  • Rectal bleeding
  • Anal fissures
  • Rectal surgery (end-to-end anastomosis)
  • Inflammatory bowel disease
  • Prior radical prostatectomy
  • Hip replacement
  • Certain types of penile implants
  • Vascular clips
  • Known anaphylactic reaction to latex compounds
  • Anticoagulant drugs
  • Severe claustrophobia
  • Cardiac pacemaker
  • Metal in eye
  • Any other metallic or foreign object in the body

• Unstable serious co-morbidities including, but not limited to, myocardial infarction, coronary artery syndrome, cardiac arrhythmias, symptomatic congestive heart failure, or cerebrovascular accident

• Major medical or psychiatric illness that, in the investigator's opinion, would preclude the completion of treatment and interfere with follow up

• Known hypersensitivity to any 5α-reductase inhibitor or drug chemically related to the study drug

• Prior radical surgery (prostatectomy) or cryosurgery for prostate cancer

• Prior pelvic irradiation, prostate brachytherapy, or bilateral orchiectomy

• Prior or concurrent cytotoxic chemotherapy for prostate cancer

• Prior hormonal therapy, such as luteinizing hormone-releasing hormone agonists (e.g., goserelin or leuprolide acetate), antiandrogens (e.g., flutamide or bicalutamide), or estrogens (e.g., diethylstilbestrol)

• Prior or concurrent finasteride, dutasteride, other drugs with known antiandrogenic properties (e.g., spironolactone or progestational agents), or any dietary or herbal supplement (e.g., selenium, vitamin E, saw palmetto, or PC-SPES)