Long-term use of 5-alpha-reductase inhibitors is safe and effective in men on active surveillance for prostate cancer

Background Although 5-alpha-reductase inhibitors (5ARIs) have been shown to benefit men with prostate cancer (PCa) on active surveillance (AS), their long-term safety remains controversial. Our objective is to describe the long-term association of 5ARI use with PCa progression in men on AS. Material...

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Bibliographic Details
Published in:Prostate cancer and prostatic diseases 2021-03, Vol.24 (1), p.69-76
Main Authors: Finelli, A., Komisarenko, M., Martin, L. J., Timilshina, N., Jain, K., Morris, J., Zlotta, A., Kulkarni, G., Perlis, N., van der Kwast, T., Evans, A., Ghai, S., Fleshner, N., Alibhai, S. M. H., Hamilton, R. J.
Format: Article
Language:English
Subjects:
631/67/1059
631/67/589/466
Analysis
Biomedical and Life Sciences
Biomedicine
Cancer Research
Dependent variables
Inhibitors
Prostate cancer
Reductases
Regression analysis
Surveillance
Time dependence
Tumors
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Summary:Background Although 5-alpha-reductase inhibitors (5ARIs) have been shown to benefit men with prostate cancer (PCa) on active surveillance (AS), their long-term safety remains controversial. Our objective is to describe the long-term association of 5ARI use with PCa progression in men on AS. Materials/subjects and methods The cohort of men with low-risk PCa was derived from a prospectively maintained AS database at the Princess Margaret (1995–2016). Pathologic, grade, and volume progression were the primary end points. Kaplan–Meier time-to-event analysis was performed and Cox proportional hazards regression was used to determine predictors of progression where 5ARI exposure was analyzed as a time-dependent variable. Patients who came off AS prior to any progression events were censored at that time. Results The cohort included 288 men with median follow-up of 82 months (interquartile range: 37–120 months). Among non-5ARI users ( n  = 203); 114 men (56.2%) experienced pathologic progression compared with 24 men (28.2%) in the 5ARI group ( n  = 85), ( p  
ISSN:1365-7852
1476-5608
DOI:10.1038/s41391-020-0218-2