1. 5-Alpha reductase inhibitor use and prostate cancer survival in the Finnish Prostate Cancer Screening Trial
- Author
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Kirsi Talala, Teuvo L.J. Tammela, Anssi Auvinen, Teemu J. Murtola, Kimmo Taari, and Elina K Karppa
- Subjects
Oncology ,Gynecology ,Cancer Research ,medicine.medical_specialty ,business.industry ,Proportional hazards model ,Hazard ratio ,030232 urology & nephrology ,medicine.disease ,3. Good health ,03 medical and health sciences ,5 Alpha-Reductase Inhibitor ,Prostate cancer ,0302 clinical medicine ,Prostate cancer screening ,medicine.anatomical_structure ,Lower urinary tract symptoms ,Prostate ,030220 oncology & carcinogenesis ,Internal medicine ,Medicine ,business ,Mass screening - Abstract
Randomized clinical trials have shown that use of 5α-reductase inhibitors (5-ARIs) lowers overall prostate cancer (PCa) risk compared to placebo, while the proportion of Gleason 8-10 tumors is elevated. It is unknown whether this affects PCa-specific survival. We studied disease-specific survival by 5-ARI usage in a cohort of 6,537 prostate cancer cases diagnosed in the Finnish Prostate Cancer Screening Trial and linked to the national prescription database for information on medication use. Cox proportional hazards regression was used to estimate hazard ratios and 95% confidence intervals for prostate cancer-specific deaths. For comparison, survival among alpha-blocker users was also evaluated. During the median follow-up of 7.5 years after diagnosis a total of 2,478 men died; 617 due to prostate cancer and 1,861 due to other causes. The risk of prostate cancer death did not differ between 5-ARI users and nonusers (multivariable adjusted HR 0.94, 95% CI 0.72-1.24 and HR 0.98, 95% CI 0.69-1.41 for usage before and after the diagnosis, respectively). Alpha-blocker usage both before and after diagnosis was associated with increased risk of prostate cancer death (HR 1.29, 95% CI 1.08-1.54 and HR 1.56, 95% CI 1.30-1.86, respectively). The risk increase vanished in long-term alpha-blocker usage. Use of 5-ARIs does not appear to affect prostate cancer mortality when used in management of benign prostatic hyperplasia. Increased risk associated with alpha-blocker usage should prompt further exploration on the prognostic role of lower urinary tract symptoms.
- Published
- 2016