Impact of 5α-Reductase Inhibitors and α-Blockers for Benign Prostatic Hyperplasia on Prostate Cancer Incidence and Mortality.

To investigate the use of 5α-reductase inhibitors (5ARIs) and α-blockers among men with benign prostatic hyperplasia (BPH) in relation to prostate cancer (PC) incidence, severity, and mortality.

A retrospective 20-year cohort study in Saskatchewan men aged 40-89 years with a BPH-coded medical claim between 1995 and 2014 was conducted. Cox proportional hazards regression was used to compare incidence of a PC diagnosis, metastatic PC, Gleason score 8-10 PC, and PC mortality among 5ARI users (n=4,571), α-blocker users (n=7,764), and non-users (n=11,677).

In comparison with both non-users and α-blocker users, 5ARI users had approximately 40% lower risk of a PC diagnosis (11.0% and 11.4% vs. 5.8%, respectively); α-blocker users had 11% lower risk of a PC diagnosis compared with non-users. Overall, there was no significant increase in metastatic PC or PC mortality among 5ARI or α-blocker users (metastatic PC: 0.8% and 1.5% vs. 1.4% [non-users]; PC mortality: 1.2% and 2.4% vs. 2.2% [non-users], respectively, P>0.05 for both drugs) but there was approximately 30% higher risk of Gleason score 8-10 cancer (1.4% and 1.8% vs. 2.0% [non-users], aHR: 1.37, 95% CI: 1.03-1.82, P=0.03 and aHR: 1.28, 95% CI: 1.03-1.59, P=0.02, respectively) compared with non-users.

5ARI use was associated with lower risk of a PC diagnosis, regardless of comparison group. Risk of high-grade PC was higher among both 5ARI users and α-blocker users compared with non-users; however, this did not translate into higher risk of PC mortality. This article is protected by copyright. All rights reserved.

BJU international. 2018 Sep 14 [Epub ahead of print]

Maria I Van Rompay, J Curtis Nickel, Gayatri Ranganathan, Philip W Kantoff, Keith R Solomon, Jennifer L Lund, John B McKinlay

HealthCore/NERI, 480 Pleasant Street, Watertown, MA, 02472, USA., Queen's University and Kingston General Hospital, Kingston, Ontario, Canada., Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, 10065, USA., Department of Orthopaedic Surgery, Harvard Medical School, and the Departments of Orthopaedic Surgery and Urology, Boston Children's Hospital, Boston, MA, 02115, USA., Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA.