5 alpha-Reductase Inhibitors and Risk of Prostate Cancer Death

• Purpose: 5 alpha-Reductase inhibitors reduced the risk of prostate cancer in 25% in 2 randomized trials but increased the risk of Gleason 8-10 at biopsy. One explanation is that 5 alpha-reductase inhibitors induce morphological changes in prostate cancer cells similar to higher Gleason grades but without its adverse biology. We compared risk of prostate cancer death between men on 5 alpha-reductase inhibitors and men not on 5 alpha-reductase inhibitors before prostate cancer diagnosis in each Gleason Grade Group. Materials and Methods: Prostate Cancer data Base Sweden consists of linkages between the National Prostate Cancer Register, the Prescribed Drug Registry and the Cause of Death Registry. Of 89,227 men diagnosed with prostate cancer between July 2007 and December 2016, 5,816 had been on 5 alpha-reductase inhibitors for more than 180 days before the date of diagnosis. Followup ended in December 2018. A Cox proportional hazard model was used to assess hazard ratio for prostate cancer death. Adjustments for age, comorbidity, education and curative treatment were made. Men with high risk cancer were stratified according to Gleason Grade Group. Results: In men with high risk cancer the risk of prostate cancer death was similar among 5 alpha-reductase inhibitor users and nonusers, with Gleason Grade Group 1 HR 1.02 (95% CI 0.53-1.95), Gleason Grade Group 2 HR 1.04 (95% CI 0.65-1.69), Gleason Grade Group 3 HR 1.27 (95% CI 0.89-1.80), Gleason Grade Group 4 HR 0.95 (95% CI 0.76-1.18) and Gleason Grade Group 5 HR 0.99 (95% CI 0.83-1.19), for 5 alpha-reductase inhibitor users vs nonusers. Conclusions: We found no evidence that 5 alpha-reductase inhibitors affect Gleason grading as no difference in mortality was observed among 5 alpha-reductase inhibitor users and nonusers in each Gleason group.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Urology and Nephrology (hsv//eng)

Keyword

5-alpha reductase inhibitors

finasteride

dutasteride

prostatic hyperplasia

neoplasm grading

Publication and Content Type

ref (subject category)

art (subject category)