5 alfa-reductase inhibitors not significantly associated with prostate cancer mortality: JAMA

There was no statistically significant correlation between the use of 5 alfa-reductase inhibitor (5-ARI) and prostate cancer (PCa) mortality in a recent systematic review and meta-analysis by Michael Baboudjian and colleagues, which draws on more than 3 million patients and more than 20 years' worth of epidemiologic literature. Nevertheless, the study offers valuable information for guiding clinical care. The findings of this study were published in JAMA Oncology.

Recently, conflicting findings on the relationship between the usage of 5-reductase inhibitors (5-ARI) and prostate cancer mortality have been revealed in a number of large, high-quality research. In order to carefully assess the available data relating the usage of 5-ARI and PCa mortality, this study was undertaken.

Through August 2022, a literature search was carried out utilizing the Embase, PubMed/Medline, and Web of Science databases. Studies were considered admissible if they compared 5-ARI users and nonusers in randomized clinical trials and prospective or retrospective cohort studies that examined PCa mortality in male patients of any age who were 5-ARI users. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting standard were followed while reporting this study. HRs with adjustments were taken from publications that had already been published.

PCa mortality among 5-ARI users in comparison to nonusers was the main result. The link between 5-ARI usage and PCa mortality was studied using the inverse variance approach with adjusted HRs and random-effect models. Prostate-specific antigen level and baseline PCa diagnosis were the two major variables that underwent two subgroup analyses to evaluate their impact.

The key findings of this study were:

1. Of the 1200 distinct records examined, 11 research satisfied the inclusion requirements.

2. A total of 3 243 575 patients were enrolled, including 3 105 098 nonusers and 138 477 5-ARI users.

3. The usage of 5-ARI and PCa mortality had no statistically significant correlation.

4. When the analysis was limited to studies that excluded participants with a PCa diagnosis at baseline or the analysis was limited to studies that were corrected for prostate-specific antigen, no significant correlation was discovered.

Reference:

Baboudjian, M., Gondran-Tellier, B., Dariane, C., Fiard, G., Fromont, G., Rouprêt, M., & Ploussard, G. (2023). Association Between 5α-Reductase Inhibitors and Prostate Cancer Mortality. In JAMA Oncology. American Medical Association (AMA). https://doi.org/10.1001/jamaoncol.2023.0260