5-Alpha Reductase Inhibitors and Prostate Cancer Mortality among Men with Regular Access to Screening and Health Care

• Published in: Cancer epidemiology, biomarkers & prevention Vol. 31; no. 7; pp. 1460 - 1465
• Main Authors: Vaselkiv, Jane B, Ceraolo, Carl, Wilson, Kathryn M, Pernar, Claire H, Rencsok, Emily M, Stopsack, Konrad H, Grob, Sydney T, Plym, Anna, Giovannucci, Edward L, Olumi, Aria F, Kibel, Adam S, Preston, Mark A, Mucci, Lorelei A
• Format: Journal Article
• Language: English
• Published: United States 01-07-2022
• Subjects: 5-alpha Reductase Inhibitors - therapeutic use; Delivery of Health Care; Early Detection of Cancer; Follow-Up Studies; Humans; Male; Medicin och hälsovetenskap; Prostate - pathology; Prostate-Specific Antigen; Prostatic Neoplasms - pathology
• ISSN: 1055-9965; 1538-7755; 1538-7755
• DOI: 10.1158/1055-9965.EPI-21-1234

How 5-alpha reductase inhibitor (5-ARI) use influences prostate cancer mortality is unclear. The objective of this study was to determine whether men taking 5-ARIs with regular health care access have increased prostate cancer mortality.
We undertook two analyses in the Health Professionals Follow-up Study examining 5-ARI use, determined by biennial questionnaires, and prostate cancer. A cohort analysis followed 38,037 cancer-free men for prostate cancer incidence from 1996 through January 2017 and mortality through January 2019. A case-only analysis followed 4,383 men with localized/locally advanced prostate cancer for mortality over a similar period. HRs and 95% confidence intervals (CI) were calculated for prostate cancer incidence and mortality.
Men using 5-ARIs underwent more PSA testing, prostate exams and biopsies. Over 20 years of follow-up, 509 men developed lethal disease (metastases or prostate cancer death). Among men initially free from prostate cancer, 5-ARI use was not associated with developing lethal disease [HR, 1.02; 95% confidence interval (CI), 0.71-1.46], but was associated with reduced rates of overall and localized disease (HR, 0.71; 0.60-0.83). Among men diagnosed with prostate cancer, there was no association between 5-ARI use and cancer-specific (HR, 0.78; 95% CI, 0.48-1.27) or overall survival (HR, 0.88; 95% CI, 0.72-1.07).
Men using 5-ARIs were less likely to be diagnosed with low-risk prostate cancer, without increasing long-term risk of lethal prostate cancer or cancer-specific death after diagnosis.
Our results provide evidence that 5-ARI use is safe with respect to prostate cancer mortality in the context of regular health care access. See related commentary by Hamilton, p. 1259.