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A Bioluminescent and Fluorescent Orthotopic Syngeneic Murine Model of Androgen-dependent and Castration-resistant Prostate Cancer
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Five-alpha-reductase Inhibitors for prostate cancer prevention.

T J Wilt1, R MacDonald, K Hagerty

  • 1VAMC, General Internal Medicine (111-0), One Veterans Drive, Minneapolis, Minnesota 55417, USA. Tim.Wilt@med.va.gov

The Cochrane Database of Systematic Reviews
|April 22, 2008
PubMed
Summary
This summary is machine-generated.

Five-alpha-reductase inhibitors (5ARI) significantly reduce prostate cancer risk, particularly in men with lower PSA levels. However, they may increase the risk of high-grade tumors in those undergoing regular screening.

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Area of Science:

  • Urology
  • Oncology
  • Pharmacology

Background:

  • Five-alpha-reductase inhibitors (5ARI) are widely used for benign prostatic hyperplasia and male pattern baldness.
  • These inhibitors show potential as chemopreventive agents, particularly for prostate cancer.

Purpose of the Study:

  • To evaluate the efficacy and safety of 5ARI in preventing prostate cancer.
  • To analyze prostate cancer outcomes in men treated with 5ARI.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs) from MEDLINE, PreMEDLINE, and Cochrane Library up to April 2007.
  • Included RCTs were of at least 1-year duration for prostate cancer outcomes and 6 months for non-prostate cancer outcomes.
  • Primary outcome was 'for-cause' prostate cancer prevalence, defined by clinical detection or abnormal screening results.

Main Results:

  • Nine trials reported prostate cancer prevalence; finasteride showed a 26% relative risk reduction in for-cause prostate cancers (absolute risk reduction 1.4%).
  • Pooled analysis of six trials indicated a 26% relative reduction in overall prostate cancers with 5ARI use (absolute reduction 2.9%).
  • Benefits were consistent across demographics but limited to men with baseline PSA < 4.0 ng/mL; higher-grade tumors increased in one trial (PCPT), and sexual side effects were more common.

Conclusions:

  • 5ARI effectively reduce prostate cancer incidence, especially in men with PSA < 4.0 ng/mL.
  • A potential increased risk of high-grade prostate cancer exists in men undergoing regular screening.
  • Further research is needed to clarify the impact on mortality and in unscreened populations.