Another study confirms benefit without risk of finasteride/dutasteride use

This large study confirms the prevailing view.

5-alpha reductase inhibitors and prostate cancer mortality among men with regular access to screening and health care (2022)

"Abstract
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 healthcare 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. Hazard ratios (HR) and 95% confidence intervals 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, 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, 0.48-1.27) or overall survival (HR 0.88, 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 healthcare access."
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AFAIK, this class of medication, widely used for BPH, is still not approved for PCa prevention (and I'm not sure approval is likely if it lowers the risk of low-risk PCa only). The good news is that these result agree with other studies that the concern about this class of medication increasing the incidence of high-grade cancer was unfounded.

It's of some consolation to know that the Proscar I took for years for BPH wasn't a contributing factor to my subsequent high-grade PCa.

Djin

Cigafred said...
So, I register for access to the full text only to be told after registering that it will cost me $50. Mainly I wanted to see how many were taking 5-ARIs. Might have been a small number, hence the wide confidence intervals. Grasping at straws since I would like to believe 5-ARIs help.

From the Full Text:

"Results

Full Cohort Study
Out of 38,037 men, 5,099 (13.4%) men reported ever use of 5-ARIs between 1996-2016 (Table 1), with a median duration of use of four years. Ever users were older on average than never users (63.4 vs. 62.8 years). In addition, men who had ever used 5-ARIs were more likely to have had recent PSA screening (prevalence difference 16%, 95% CI 15-18%) and were more likely to have had a prostate biopsy or rectal ultrasound prior to 1996 (prevalence difference 11%, 95% CI 10-13%). Participants contributed 628,257 person-years over the study period, during which 4,575 men developed prostate cancer and 509 developed lethal disease (Table 2).
Among men diagnosed with prostate cancer, 83.7% presented with localized disease, and 71.8% presented with a Gleason score of 3+4 or lower. In both ageadjusted and fully-adjusted models, we found no association between ever use of 5- ARIs and lethal (mHR 1.02, 0.71-1.46), advanced (mHR 1.02, 0.73-1.41) or high-grade prostate cancer (mHR 1.06, 0.84-1.33). In fully-adjusted models, there was a 21% reduced risk of overall prostate cancer (95% CI, 0.70-0.90), a 29% lower risk of localized disease (95% CI, 0.60-0.83), and a 38% reduced risk of low-grade disease (95% CI, 0.51-0.74). We found similar results examining duration of use (<4 and ≥4 years).

Case-Only Study
In the case-only group of 4,383 men with localized/locally-advanced prostate cancer, 235 (5.4%) men ever used 5-ARIs (Supplementary Table 1). Ever users were on average older than never users (75.1 vs. 70.3 years) and had shorter follow-up (10.4 vs. 11.8 years). Diagnostic PSA levels were approximately equal between ever and
never users of 5-ARIs (8.9 vs. 8.8 ng/mL never users). Ever users also had a slightly higher percent of stage T1 cancer (77% vs. 69% never users) and a slightly higher percent of Gleason ≤6 cancer (53% vs. 47% never users).
At the end of follow-up, 320 men in the case-only cohort developed lethal prostate cancer (Table 3). In the fully-adjusted multivariable model, there was no association between ever using 5-ARIs and total mortality (mHR 0.88, 0.72-1.07) or lethal prostate cancer (mHR 0.78, 0.48-1.27). Findings were similar stratifying by duration of use."

Post Edited (DjinTonic) : 3/18/2022 5:27:20 AM (GMT-6)