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Updated: May 1, 2026
A New Technique for Treating Low-risk Prostate Cancer—Super Active Surveillance
Published on: November 7, 2025
5-Alpha reductase inhibitors in active surveillance
Patrick O Richard1, Antonio Finelli
1aDivision of Urology, Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Purpose Of Review:
Active surveillance is now one of the recommended treatment options for low-risk prostate cancer (PCa). However, about 10-30% of men on active surveillance will progress and require definitive therapy. In this review, we examine the role of 5-alpha reductase inhibitors (5-ARIs) in secondary prevention among men with low-risk PCa who opted to be managed by active surveillance.
Recent Findings:
Three retrospective studies and one randomized controlled trial have evaluated the role of 5-ARIs in preventing clinical progression among men followed by active surveillance. These studies largely support the role of 5-ARIs for secondary chemoprevention, although the drugs do not have an indication for this setting.
Summary:
5-ARIs have been shown to play an important role in preventing clinical progression among men with low-risk PCa on active surveillance. However, in light of the US Food and Drug Administration recommendation against 5-ARIs for primary chemoprevention, these findings should be interpreted with caution. Patients should be made aware of this warning label before starting the drug.
Insights
5-alpha reductase inhibitors (5-ARIs) show promise in preventing prostate cancer progression for men on active surveillance. However, caution is advised due to FDA warnings against their use for primary prevention.
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.
