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