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Treatment with 5-alpha-reductase inhibitors (5-ARIs) is associated with worse mortality in prostate cancer, report findings from Veterans Affairs electronic health records.
Dr. Brent S. Rose, from the University of California, San Diego in La Jolla, said, "5-ARIs, like finasteride and dutasteride, reduce the PSA by about 50%. It is very important to adjust the PSA for men on 5-ARIs to avoid the possibility of delayed prostate cancer detection."
Using data from the Veterans Affairs Informatics and Computing Infrastructure, Dr. Rose and colleagues tested the hypothesis that 5-ARI-induced PSA suppression may lead to delays in prostate cancer diagnosis, higher grade and stage at diagnosis, and higher risk of prostate cancer-specific mortality. The median delay from first elevated (adjusted) PSA to prostate biopsy was significantly longer among 5-ARI users (3.60 years) than among those taking alpha-blockers (2.11 years) or those taking neither alpha-blockers nor 5-ARIs (1.17 years). The 12-year cumulative incidence of prostate cancer-specific mortality and all-cause mortality were significantly higher among men who received 5-ARIs (13% and 45%, respectively) as compared to men who received alpha-blockers (8% and 42%, respectively) or those who received neither medication (8% and 36%, respectively). The findings were published online in JAMA Internal Medicine.