Prostate Cancer Death Risk Not Linked to 5-ARIs

The following article features coverage from the 2020 Genitourinary Cancers Symposium meeting. Click here to read more of Renal and Urology News’ conference coverage.

SAN FRANCISCO—Use of 5-alpha-reductase inhibitors (5-ARIs) is not associated with an increased risk of death from prostate cancer (PCa), according to data presented at the 2020 Genitourinary Cancers Symposium.¹

Lorelei Mucci, ScD, MPH, of the Harvard T.H. Chan School of Public Health in Boston, and colleagues performed two parallel analyses of data from the Health Professionals Follow-up Study. In that study, male health professionals reported 5-ARI use or non-use on biennial questionnaires starting in 1996. Dr Mucci’s team examined 38,047 men for PCa incidence and mortality through 2016 and conducted a case-only study of 4225 men with localized/locally advanced PCa followed over a similar period.

A total of 4101 men (10.7%) reported having ever used 5-ARIs, according to the investigators. These men were more likely to have had regular PSA screening (74% vs 57% for non-users) and were more likely to have had a negative prostate biopsy prior to diagnosis (21% vs 9%). The investigators found no association between 5-ARI use overall or for longer use and risk of PCa death.

As expected, median PSA levels at diagnosis were lower among men using 5-ARIs (10 vs 16 ng/mL for non-users). Among nonmetastatic cases, 278 men died from PCa, but Dr Mucci’s team observed no association between 5-ARIs and PCa survival.

The new findings are in line with a study of participants in the Prostate Cancer Prevention Trial (PCPT),² which found no excess PCa mortality risk among 5-ARI recipients, but contrast with the findings of a study of veterans showing that prediagnostic use of 5-ARIs was associated with delayed PCa diagnosis and worse cancer-specific and overall survival in men with PCa.³ Men on 5-ARIs in the Health Professionals Follow-up Study had greater interactions with the healthcare system, which may underlie the lack of increased cancer mortality. Dr Mucci and her colleagues noted that these data show the importance of using real world data to examine the benefits and risks of 5-ARIs.

Read more of our coverage of the 2020 Genitourinary Cancers Symposium by visiting the conference page.

References

1. Mucci L, Pernar C, Rencsok E, et al. 5 alpha-reductase inhibitors (5-ARI) and prostate cancer mortality among men with regular access to screening and health. Presented at the 2020 Genitourinary Cancers Symposium held February 13 to 15 in San Francisco. Poster B5.
2. Hershman DL, Till C, Tangen CM, et al. Using Medicare claims to examine long-term prostate cancer risk of finasteride in the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2018;110;1218-1215. doi: 10.1093/jnci/djy035
3. Sarkar RR, Parsons K, Bryant AK, et al. Association of treatment with 5α-reductase inhibitors with time to diagnosis and mortality in prostate cancer. JAMA Intern Med. 2019;179:812-819. doi: 10.1001/jamainternmed.2019.0280