5-alpha-reductase inhibitors beneficial to men with prostate cancer

Men with prostate cancer (PCa) on active surveillance appear to fare well with 5-alpha-reductase inhibitors (5ARIs), which can help reduce both grade and volume progression without increasing the risk of developing high-grade tumours, a study has found.

The analysis included a cohort of 288 men with low-risk PCa from a prospectively maintained active surveillance database (1995–2016). Of these, 85 were used 5ARI while 203 did not. Pathologic, grade, and volume progression were the primary endpoints.

Kaplan–Meier and Cox proportional hazards regression facilitated identification of progression in relation to 5ARI exposure as a time-dependent variable. Patients who came off active surveillance prior to any progression events were excluded.

Over a median follow-up of 82 months (interquartile range, 37–120), there were much fewer 5ARI users who had pathologic progression: 24 as opposed to 114 nonusers (28.2 percent vs 56.2 percent; p<0.001).

The group of 5ARI users also experienced less frequent incidences of increased tumour volume (15 [17.7 percent] vs 87 [43.1 percent]; p<0.001) and volume progression (19 [22.4 percent] vs 82 [40.4 percent]; p=0.003).

Nonuse of 5ARI was confirmed to be positively associated with pathologic progression (hazard ratio [HR], 2.65, 95 percent confidence interval [CI], 1.65–4.24), grade progression (HR, 2.75, 95 percent CI, 1.49–5.06), and volume progression (HR, 3.15, 95 percent CI, 1.78–5.56).

Meanwhile, the frequency of progression to high-grade (grade 4–5) diseases was similar in users and nonusers of 5ARI.