BPH Patients Using 5-ARIs Not at Higher Risk of Dying of Prostate Cancer, Study Reports

Joana Fernandes, PhDby Joana Fernandes, PhD

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BPH Patients Using 5-ARIs Not at Higher Risk of Dying of Prostate Cancer, Study Reports

Patients with benign prostatic hyperplasia (BPH) who are treated with enzyme 5-alpha reductase inhibitors (5-ARIs) are not at a higher risk of dying of prostate cancer than those using α-blockers, a new study reports.

Results of the study, “5-Alpha Reductase Inhibitors And The Risk Of Prostate Cancer Mortality In Men Treated For Benign Prostatic Hyperplasia,” were published in the journal Mayo Clinic Proceedings.

BPH treatments include α-blockers, which have been shown to improve maximal flow rate and patient quality of life, and inhibitors of the enzyme 5-alpha reductase (5-ARIs), such as Propecia (finasteride) and Avodart (dutasteride), which reduce total prostate volume and surgical risk in long-term follow-ups.

5-ARIs reduce prostate size by blocking the conversion of testosterone to dihydrotestosterone, and “have been suggested as potential chemopreventive agents for prostate cancer,” the researchers wrote. But before “the safety of using 5-ARIs for the primary prevention of prostate cancer can be established, studies assessing their long-term use in community practice settings are necessary.”

Addressing this, researchers analyzed medical data from two groups of BPH patients, one a cohort of 174,895 patients and the other a case-control group of 18,311 BPH patients with prostate cancer.

Enrolled patients were age 50 or older and had at least three consecutive treatment prescriptions between January 1992 and December 2007. Researchers investigated the incidence of prostate cancer-specific mortality associated with 5-ARI use (alone and in combination with α-blockers) and α-blocker use.

In the first group, 1,053 BPH patients were found to have died of prostate cancer during a three-year follow-up. These patients represented 15 percent of the 5-ARIs users, but 85 percent of the α-blockers users in the study. This led researchers, after accounting for other causes, to conclude that 5-ARI therapy use was “not associated with prostate cancer mortality” when compared use of α-blockers.

Similar results were obtained during the analysis of patients in the case-control group.

“The results of this large, population-based study in community practice settings suggest that the use of 5-ARIs to treat BPH/LUTS is not associated with an increased risk of prostate cancer mortality when compared with [α-blockers] use,” the researchers wrote. “Although there was an increase in [the aggressiveness of] prostate cancers diagnosed among men treated with 5-ARIs (among those for whom we had [aggressiveness data]) in this population, this did not translate into an increased risk of prostate cancer death.”

And, they added, “uncertainty continues to exist regarding the use of 5-ARIs for the chemoprevention of prostate cancer.”

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