5-Alpha reductase inhibitors in active surveillance

Area of Science:

• Oncology
• Urology
• Pharmacology

Background:

• Active surveillance is a recommended management strategy for low-risk prostate cancer (PCa).
• A significant percentage (10-30%) of men on active surveillance may experience disease progression requiring definitive treatment.
• Secondary prevention strategies are crucial for men managed conservatively.

Purpose of the Study:

• To review the role of 5-alpha reductase inhibitors (5-ARIs) in secondary chemoprevention for low-risk prostate cancer patients undergoing active surveillance.
• To evaluate the efficacy of 5-ARIs in preventing clinical progression within this patient cohort.

Main Methods:

• Review of three retrospective studies and one randomized controlled trial.
• Analysis of data evaluating the impact of 5-ARIs on clinical progression in men on active surveillance for prostate cancer.

Main Results:

• Evidence from reviewed studies largely supports the use of 5-ARIs for secondary chemoprevention in men with low-risk PCa on active surveillance.
• These agents demonstrated a role in preventing clinical progression in the evaluated studies.

Conclusions:

• 5-ARIs appear to be important in preventing clinical progression for men with low-risk prostate cancer managed by active surveillance.
• Findings should be interpreted cautiously due to the US FDA's recommendation against 5-ARIs for primary chemoprevention.
• Informed patient consent regarding the FDA warning label is essential before initiating 5-ARIs.