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

Abstract

Background The efficacy and safety of 5α-reductase inhibitors (5ARIs) in treating prostate cancer (PCa) have not been fully determined. We performed a meta-analysis to evaluate the effectiveness and safety of 5ARIs for PCa patients. Methods A comprehensive literature search of online databases was conducted to obtain comparative studies exploring the effectiveness and safety of 5ARIs in treating PCa up to October 2019. Summarized odds ratio s (OR s) or hazard ratio s (HR s) were calculated to compare the outcomes between 5ARI and control groups. Our meta-analysis was registered in PROSPERO under number CRD42018109809. Results A total of 2,277 patients from 10 studies were included. No significant difference was found in prostate-specific antigen progression between two groups (OR = 0.82, 95% CI [0.52–1.29], P = 0.40). However, 5ARI treatment significantly reduced the total progression of PCa (OR = 0.61, 95% CI [0.48–0.77], P < 0.0001), especially for patients with local (OR = 0.56, 95% CI [0.44–0.73], P < 0.00001) and low-Gleason score (≤7) PCa (OR = 0.63, 95% CI [0.48–0.84], P = 0.002). Additionally, 5ARIs also significantly prolonged the progression-free survival time (HR = 0.57, 95% CI [0.34–0.96], P = 0.04) for PCa patients. No significant difference was found in the occurrence of PCa recurrence, metastasis, biopsy reclassification, and side-effects between two groups. Conclusions Our study suggests that 5ARI treatment can benefit patients with local and low Gleason score (≤7) PCa, especially in delaying the disease progression. More studies with larger sample size and comprehensive study design are still needed to verify our outcomes.

5-alpha reductase inhibitors use in prostatic disease and beyond

“…This meta-analysis observed no statistically significant difference between high-grade prostate cancer diagnoses and 5-ARI use (RR 0.98, 95% CI: 0.67-1.43, I 2 =75%). Furthermore, they observed no statistically significant difference in prostate cancer-specific mortality rates between the 5-ARI exposure arm and the control arm, a finding supported by three other meta-analyses, along with multiple other publications (42,43,(45)(46)(47)(48)(49)(50)(51).…”

Patterns of finasteride and dutasteride use in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial cohort: effects of socio-demographic factors and a black box warning

“…Given the long-term follow-up data and clear evidence of benefit in terms of risk reduction of lowrisk prostate cancer, these drugs might warrant consideration for this indication in selected men, particularly those with lower urinary tract symptoms [26]. A recent systematic review [27] using over 2000 patients from 10 studies showed a statistically significant decrease in prostate cancer risk associated with use of 5-ARI drugs.…”

Cinnamomum cassia and Rosa laevigata Mixture Improves Benign Prostatic Hyperplasia in Rats by Regulating Androgen Receptor Signaling and Apoptosis

“…Finasteride and dutasteride, two primary 5α-reductase inhibitors, have been reported with various side effects during long-term administration such as sexual adverse effects, erectile dysfunction, and loss of libido [ 20 , 21 , 22 ]; these drugs decreased ejaculation by 3.4 to 15.8 percent in men [ 23 ]. In addition, the use of 5α-reductase inhibitors for BPH can be the reason for prostate cancer and the risk of all-cause mortality [ 24 , 25 ]. Moreover, tamsulosin, an α 1A -adrenergic receptor blocker, may increase the risk of dementia in older men with BPH via its selectivity relative to α 1A -adrenoceptors in the brain [ 26 , 27 ].…”