Abstract
Objective
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.
Results
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).
Conclusion
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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 27, 2016
Footnotes
Grant Support: The work was supported by a research grant (no. 116059) from GlaxoSmithKline. Although the sponsor had an opportunity to comment on the manuscript, it did not have access to the data and all analyses were conducted at Kaiser Permanente Southern California. Drs Wallner and Jacobsen had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr Wallner made the final decision to submit this manuscript for publication and was not paid by any other organization or agency to write this article.
Potential Competing Interests: Drs Wallner, DiBello, Van Den Eeden, Abell, Jacobsen, D'Agsotino Jr, Loo, and Horwitz report funding from GlaxoSmithKline for this study. Dr Van Den Eeden report funding from Takeda not related to the topic of this study. Drs Li, Weinmann, Ritzwoller, Aaronson, and Richert-Boe have no additional financial disclosures to report.
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© 2016 Mayo Foundation for Medical Education and Research
