Current use of 5-alpha reductase inhibitors (5-ARI) is another reason to perform a biopsy for prostate cancer, investigators suggested in a poster presentation during the AUA2021 Virtual Experience.

“While not emphasized in common risk calculators, pre-diagnostic use of 5-ARI should be considered when deciding to biopsy,” lead investigator James T. Kearns, MD, of Levine Cancer Institute in Charlotte, North Carolina, said in an interview. “The use of 5-ARIs reduces PSA by approximately 50%, and I do believe it is associated with a delay in the diagnosis of prostate cancer.”

A 2019 retrospective study published in JAMA Internal Medicine revealed an association between 5-ARI use and delayed diagnosis of prostate cancer and worse oncologic outcomes. Dr Kearns and his colleagues at the institute compared clinical characteristics and treatments between 5-ARI users and nonusers at prostate biopsy and prostate cancer diagnosis to identify possible risk factors.

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At their institution, 143 men were taking 5-ARIs at the time of prostate biopsy and 910 men were not. Demographic characteristics appeared similar between groups, but men taking 5-ARIs had a significantly higher median prostate volume (51.1 vs 43.4 mL) and nonsignificantly higher median PSA values (8.2 vs 6.4 ng/mL).

At prostate cancer diagnosis, 5-ARI users were significantly more likely to have a higher clinical T stage compared with nonusers: 12.7% vs 8.7% had cT2 and 4.2% vs 0.9% had cT3-4, respectively, Dr Kearns and his colleagues reported. More 5-ARI users than nonusers also were stratified into National Comprehensive Cancer Network (NCCN) high-risk (30.3% vs 25.9%) and intermediate-risk (50.5% vs 43.0%) categories, respectively. Gleason Grade Group, digital rectal examination findings, and treatment type did not differ significantly between groups.

“These findings suggest that 5-ARI [use] is an important risk factor to be considered at referral and highlight the need to optimize diagnostic care for 5-ARI users,” the investigators concluded.


Roebuck E, Sha W, Lu C, et al. 5-ARI usage associated with more advanced prostate cancer at diagnosis. Presented at: AUA2021 Virtual Experience held September 10-13, 2021. Abstract MP30-14.

Sarkar RR, Kellog Parsons J, Bryant AK, et al. Association of treatment with 5α-reductase inhibitors with time to diagnosis and mortality in prostate cancer. JAMA Intern Med. 2019 Jun 1;179(6):812-819. doi:10.1001/jamainternmed.2019.0280