Association between 5α-reductase inhibitors therapy and incidence, cancer-specific mortality, and progression of prostate cancer: evidence from a meta-analysis

Abstract

5α-reductase inhibitors (5-ARI) are widely employed for the treatment of benign prostatic hyperplasia. It has been noted that 5-ARI exhibit the potential to attenuate the risk of prostate cancer, but consistent agreement has not been achieved. Moreover, the effect of 5-ARI on cancer-specific mortality and progression of prostate cancer remains unclear. Therefore, the goal of the current meta-analysis was to elucidate the impact of 5-ARI on the incidence and progression of prostate cancer. We searched for all studies assessing the effect of 5-ARI on risk of prostate cancer in PubMed, Embase, Medline, and Cochrane Library databases. Pooled relative risk (RR) and corresponding 95% confidence intervals (CIs) were accepted to evaluate the association between 5-ARI and the risk of prostate cancer. Synthetic results implied that subjects who accepted 5-ARI compared with the placebo group experienced a distinctly weakened overall incidence of prostate cancer (RR = 0.74; 95% CI: 0.66–0.82; P < 0.001). Subgroup analyses further revealed that 5-ARI reduction of the incidence of prostate cancer was limited to low-grade (Gleason score 2–6; RR = 0.68; 95% CI: 0.57–0.81; P < 0.001) and intermediate-grade tumors (Gleason score 7; RR = 0.81; 95% CI: 0.67–0.97; P = 0.023), but not high-grade tumors (Gleason score >7; RR = 1.19; 95% CI: 0.98–1.43; P = 0.069). The results also showed that 5-ARI treatment did not significantly alter prostate cancer-specific mortality (RR = 1.0; 95% CI: 0.95–1.05; P = 0.916). In addition, it was worth noting that 5-ARI treatment acted in a protective role that presented a dramatic benefit to delay the progression of low-risk tumors (RR = 0.58; 95% CI: 0.43–0.78; P < 0.001).

Prostate cancer patients can benefit from 5-alpha-reductase inhibitor treatment: a meta-analysis

“…Above all, 5ARIs benefited more patients with local and low Gleason score (≤7) PCa, especially in delaying the disease progression. Luo et al (2019) reported a similar meta-analysis with us recently, however, they mainly focused on the impact of 5ARIs treatment on the incidence of PCa. Although only two studies were included to evaluate the effect of 5ARIs on PCa progression, their pooled results also supported our conclusions, indicating 5ARI treatment could delay the progression of low-risk prostate cancer (Luo et al, 2019).…”

“…Furthermore, 5ARIs for treating PCa are not recommended in either European Association of Urology (EAU) or American Urological Association (AUA) guidelines due to inadequate high-level evidences. Although one meta-analysis was published recently exploring the association between 5ARIs therapy and PCa, it mainly focused on PCa's incidence and only two studies were included to evaluate the effect of 5ARI therapy on PCa progression (Luo et al, 2019). We performed this meta-analysis on published literature to evaluate the effectiveness, safety, and potential advantages of 5ARIs in the treatment of PCa.…”