4.5 Article

5-Alpha Reductase Inhibitors and Prostate Cancer Mortality among Men with Regular Access to Screening and Health Care

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CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION
卷 31, 期 7, 页码 1460-1465

出版社

AMER ASSOC CANCER RESEARCH
DOI: 10.1158/1055-9965.EPI-21-1234

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资金

  1. NCI [U01 167552]
  2. Department of Defense [W81XWH-18-1-0330, W81XWH-19-1-0412]
  3. Prostate Cancer Foundation Young Investigator Award
  4. American Urologic Association Research Scholars Program
  5. Swedish Society for Medical Research
  6. NIH [R01DK124502]
  7. Program for Training in Cancer Epidemiology [T32CA009001]

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The use of 5-alpha reductase inhibitor (5-ARI) is not associated with an increased risk of lethal prostate cancer or cancer-specific death, but is instead linked to a reduced risk of overall and localized disease. These findings suggest that 5-ARI use is safe in terms of prostate cancer mortality.
Background: 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 health care access have increased prostate cancer mortality. Methods: 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. HRs and 95% confidence intervals (CI) were calculated for prostate cancer incidence and mortality. Results: 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; 95% confi- dence interval (CI), 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; 95% CI, 0.48- 1.27) or overall survival (HR, 0.88; 95% CI, 0.72-1.07). Conclusions: 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. Impact: Our results provide evidence that 5-ARI use is safe with respect to prostate cancer mortality in the context of regular health care access.

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