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Updated: May 23, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
The role of 5-alpha-reductase inhibitors in active surveillance
1Division of Urology, Department of Surgical Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada. sdmargel@gmail.com
Purpose Of Review:
Active surveillance is now considered one of the preferred treatments for men with favorable risk prostate cancer (PCa). Unfortunately, 30-50% of men choosing active surveillance will progress and require therapy. In this context, we will present recent data on the efficacy of 5-alpha-reductase inhibitors (5-ARIs) in secondary prevention among men with low-risk PCa choosing active surveillance.
Recent Findings:
Two recent studies including a multicenter randomized controlled study demonstrate that 5-ARI may reduce the rate of clinical progression in low-risk PCa.
Summary:
5-ARIs may play an important role in secondary prevention in low-risk PCa. These results should be interpreted with caution in view of the recent US Food and Drug Administration recommendation against PCa chemoprevention labeling for 5-ARIs.
Insights
Active surveillance is a preferred treatment for low-risk prostate cancer (PCa). Recent studies suggest 5-alpha-reductase inhibitors (5-ARIs) may help prevent progression in men with PCa on active surveillance.
Area of Science:
- Oncology
- Urology
- Pharmacology
Background:
- Active surveillance is a preferred management strategy for favorable-risk prostate cancer (PCa).
- A significant percentage (30-50%) of men on active surveillance for PCa experience disease progression.
- There is a need for effective secondary prevention strategies to mitigate progression in this cohort.
Purpose of the Study:
- To review recent data on the efficacy of 5-alpha-reductase inhibitors (5-ARIs) for secondary prevention in men with low-risk PCa undergoing active surveillance.
- To assess the role of 5-ARIs in reducing clinical progression of prostate cancer in men on active surveillance.
Main Methods:
- Review of recent clinical studies, including a multicenter randomized controlled trial.
- Analysis of data evaluating the impact of 5-ARIs on prostate cancer progression rates.
Main Results:
- Two recent studies indicate that 5-ARIs may decrease the rate of clinical progression in low-risk PCa.
- Evidence suggests a potential benefit of 5-ARIs in men with PCa on active surveillance.
Conclusions:
- 5-alpha-reductase inhibitors (5-ARIs) show promise as a secondary prevention strategy for low-risk prostate cancer.
- Caution is advised due to recent FDA recommendations against 5-ARI chemoprevention labeling for PCa.
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