5-alpha reductase inhibitors and prostate cancer mortality among men with regular access to screening and health care.

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 healthcare 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. Hazard ratios (HR) and 95% confidence intervals 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, 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, 0.48-1.27) or overall survival (HR 0.88, 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 healthcare access.

Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2022 Mar 04 [Epub ahead of print]

Jane B Vaselkiv, Carl Ceraolo, Kathryn M Wilson, Claire H Pernar, Emily M Rencsok, Konrad H Stopsack, Sydney T Grob, Anna Plym, Edward L Giovannucci, Aria F Olumi, Adam S Kibel, Mark A Preston, Lorelei A Mucci

Harvard T.H. Chan School of Public Health, Boston, MA, United States., Brigham and Women's Hospital, Boston, MA, United States., Beth Israel Deaconess Medical Center, Boston, MA, United States.

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