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Original article| Volume 91, ISSUE 12, P1717-1726, December 2016

5-Alpha Reductase Inhibitors and the Risk of Prostate Cancer Mortality in Men Treated for Benign Prostatic Hyperplasia

Published:October 27, 2016DOI:



      To compare the risk of prostate cancer mortality among men treated with 5- alpha reductase inhibitors (5-ARIs) with those treated with alpha-adrenergic blockers (ABs) in community practice settings.

      Patients and Methods

      A retrospective matched cohort (N=174,895) and nested case-control study (N=18,311) were conducted in 4 regions of an integrated health care system. Men 50 years and older who initiated pharmaceutical treatment for benign prostatic hyperplasia between January 1, 1992, and December 31, 2007, and had at least 3 consecutive prescriptions were followed through December 31, 2010. Adjusted subdistribution hazard ratios, accounting for competing risks of death, and matched odds ratios were used to estimate prostate cancer mortality associated with 5-ARI use (with or without concomitant ABs) as compared with AB use.


      In the cohort study, 1,053 men died of prostate cancer (mean follow-up, 3 years), 15% among 5-ARI users (N= 25,388) and 85% among AB users (N=149,507) (unadjusted mortality rate ratio, 0.80). After accounting for competing risks, it was found that 5-ARI use was not associated with prostate cancer mortality when compared with AB use (adjusted subdistribution hazard ratio, 0.85; 95% CI, 0.72-1.01). Similar results were observed in the case-control study (adjusted matched odds ratio, 0.95; 95% CI, 0.78-1.17).


      Among men being pharmaceutically treated for benign prostatic hyperplasia, 5-ARI use was not associated with an increased risk of prostate cancer–specific mortality when compared with AB use. The increased prevalence of high-grade lesions at the time of diagnosis noted in our study and the chemoprevention trials may not result in increased prostate cancer mortality.

      Abbreviations and Acronyms:

      AB (alpha-adrenergic blocker), BPH (benign prostatic hyperplasia), 5-ARI (5-alpha reductase inhibitor), LUTS (lower urinary tract symptom), PCPT (Prostate Cancer Prevention Trial), PSA (prostate specific antigen), SHR (subdistribution hazard ratio)
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        • Thompson I.M.
        • Goodman P.J.
        • Tangen C.M.
        • et al.
        The influence of finasteride on the development of prostate cancer.
        N Engl J Med. 2003; 349: 215-224
        • Andriole G.L.
        • Bostwick D.G.
        • Brawley O.W.
        • et al.
        • REDUCE Study Group
        Effect of dutasteride on the risk of prostate cancer.
        N Engl J Med. 2010; 362: 1192-1202
        • Rubin M.A.
        • Kantoff P.W.
        Prevention of prostate cancer with finasteride.
        N Engl J Med. 2003; 349: 1569-1572
        • Scardino P.T.
        The prevention of prostate cancer — the dilemma continues.
        N Engl J Med. 2003; 349: 297-299
        • Zuger A.
        A big study yields big questions.
        N Engl J Med. 2003; 349: 213-214
        • Figg W.D.
        • Thompson I.M.
        Effect of 5α-reductase inhibitor use on mortality from prostate cancer.
        JAMA Oncol. 2015; 1: 321-322
        • LeFevre M.
        A role for finasteride in the prevention of prostate cancer?.
        N Engl J Med. 2013; 369: 670-671
        • Azoulay L.
        • Eberg M.
        • Benayoun S.
        • Pollak M.
        5A-reductase inhibitors and the risk of cancer-related mortality in men with prostate cancer.
        JAMA Oncol. 2015; 1: 314-320
        • Preston M.A.
        • Wilson K.M.
        • Markt S.C.
        • et al.
        5alpha-Reductase inhibitors and risk of high-grade or lethal prostate cancer.
        JAMA Intern Med. 2014; 174: 1301-1307
        • Thompson Jr., I.M.
        • Goodman P.J.
        • Tangen C.M.
        • et al.
        Long-term survival of participants in the prostate cancer prevention trial.
        N Engl J Med. 2013; 369: 603-610
        • Koebnick C.
        • Langer-Gould A.M.
        • Gould M.K.
        • et al.
        Sociodemographic characteristics of members of a large, integrated health care system: comparison with US Census Bureau data.
        Perm J. 2012; 16: 37-41
        • Ross T.R.
        • Ng D.
        • Brown J.S.
        • et al.
        The HMO Research Network Virtual Data Warehouse: a public data model to support collaboration.
        EGEMS (Wash DC). 2014; 2: 1049
        • Charlson M.E.
        • Pompei P.
        • Ales K.L.
        • MacKenzie C.R.
        A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
        J Chronic Dis. 1987; 40: 373-383
        • Fine J.P.
        • Gray R.J.
        A proportional hazards model for the subdistribution of a competing risk.
        J Am Stat Assoc. 1999; 94: 496-509
        • Grambsch P.M.
        • Therneau T.M.
        Proportional hazards tests and diagnostics based on weighted residuals.
        Biometrika. 1994; 81: 515-526
        • Murtola T.J.
        • Karppa E.K.
        • Taari K.
        • Talala K.
        • Tammela T.L.
        • Auvinen A.
        5-Alpha reductase inhibitor use and prostate cancer survival in the Finnish Prostate Cancer Screening Trial.
        Int J Cancer. 2016; 138: 2820-2828
      1. FDA Drug Safety Communication: 5-alpha reductase inhibitors (5-ARIs) may increase the risk of a more serious form of prostate cancer. Accessed June 30, 2015.

        • Andriole G.L.
        • Humphrey P.A.
        • Serfling R.J.
        • Grubb R.L.
        High-grade prostate cancer in the Prostate Cancer Prevention Trial: fact or artifact?.
        J Natl Cancer Inst. 2007; 99: 1355-1356
        • Goodman P.J.
        • Thompson Jr., I.M.
        • Tangen C.M.
        • Crowley J.J.
        • Ford L.G.
        • Coltman Jr., C.A.
        The prostate cancer prevention trial: design, biases and interpretation of study results.
        J Urol. 2006; 175: 2234-2242
        • Redman M.W.
        • Tangen C.M.
        • Goodman P.J.
        • Lucia M.S.
        • Coltman Jr., C.A.
        • Thompson I.M.
        Finasteride does not increase the risk of high-grade prostate cancer: a bias-adjusted modeling approach.
        Cancer Prev Res (Phila). 2008; 1: 174-181
        • Lucia M.S.
        • Darke A.K.
        • Goodman P.J.
        • et al.
        Pathologic characteristics of cancers detected in the Prostate Cancer Prevention Trial: implications for prostate cancer detection and chemoprevention.
        Cancer Prev Res (Phila). 2008; 1: 167-173
        • Thompson I.M.
        • Chi C.
        • Ankerst D.P.
        • et al.
        Effect of finasteride on the sensitivity of PSA for detecting prostate cancer.
        J Natl Cancer Inst. 2006; 98: 1128-1133
        • Cohen Y.C.
        • Liu K.S.
        • Heyden N.L.
        • et al.
        Detection bias due to the effect of finasteride on prostate volume: a modeling approach for analysis of the Prostate Cancer Prevention Trial.
        J Natl Cancer Inst. 2007; 99: 1366-1374
        • Suissa S.
        Immortal time bias in observational studies of drug effects.
        Pharmacoepidemiol Drug Saf. 2007; 16: 241-249