BPH medications tied to delayed prostate cancer diagnosis

  • Sarkar RR & al.
  • JAMA Intern Med
  • 6 May 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • Use of 5-α reductase inhibitors (5-ARIs) among men undergoing prostate-specific antigen (PSA) screening is associated with delayed prostate cancer diagnosis, more advanced disease at diagnosis, and higher mortality risk .

Why this matters

  • 5-ARIs are commonly used for benign prostatic hyperplasia (BPH) and scalp hair loss.
  • Current guidelines do not address 5-ARI-induced PSA suppression (50% reduction in serum concentrations).

Study design

  • 80,875 patients diagnosed with prostate cancer during 2001-2015, followed until 2017 (median, 5.90 years).
  • Funding: NIH.

Key results

  • 10.6% of patients received 5-ARIs ≥1 year before prostate cancer diagnosis.
  • Median time from first adjusted elevated PSA to biopsy was significantly longer in 5-ARI users vs patients receiving either blockers alone or none (3.60 vs 2.11 and 1.17 years, respectively; P<.001>
  • Median adjusted PSA at time of biopsy was 13.5 vs 6.4 and 6.4 ng/mL, respectively (P<.001>
  • Patients treated with 5-ARIs were more likely to have Gleason grade 8 or higher (25.2% vs 17.0%), clinical stage T3-T4 (4.7% vs 2.9%), node-positive (3.0% vs 1.7%), and metastatic (6.7% vs 2.9%) disease than 5-ARI nonusers (all P<.001>
  • 5-ARIs use was associated with increased risk for cancer-specific mortality (subdistribution HR, 1.39; P<.001 and all-cause mortality p>

Limitations

  • Observational design, misclassification bias.