5-α Reductase Inhibitors and Prostate Cancer Mortality.

Area of Science:

• Oncology
• Pharmacology
• Epidemiology

Background:

• 5-alpha-reductase-inhibitors (5-ARIs) are approved for benign prostatic hyperplasia (BPH) and reduce prostate cancer (PCa) risk.
• However, concerns exist regarding 5-ARIs potentially increasing high-grade PCa and their impact on mortality in diagnosed patients.

Purpose of the Study:

• To investigate the long-term mortality outcomes in men with clinically localized PCa who used 5-ARIs before diagnosis compared to non-users.

Main Methods:

• A population-based cohort study in Ontario, Canada (2003-2017) included 19,938 men aged 65+ with localized PCa.
• Inverse probability of treatment weighting (IPTW) was used to analyze associations between prediagnostic 5-ARI use and overall/PCa-specific mortality.

Main Results:

• Among 19,938 patients, 2,112 used 5-ARIs. Over a median follow-up of 8.96 years, 6,053 deaths occurred.
• After IPTW adjustment, 5-ARI use was not significantly associated with increased overall mortality (HR 0.98; 95% CI 0.90-1.07) or PCa-specific mortality (HR 1.02; 95% CI 0.83-1.25).

Conclusions:

• Prediagnostic 5-ARI use in men with localized PCa is not associated with increased PCa-specific or all-cause mortality.
• This study provides reassuring safety data for 5-ARI use prior to PCa diagnosis for BPH or chemoprevention.