Use of 5α-Reductase Inhibitors and Prostate Cancer Mortality

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In a systematic review and meta-analysis reported in JAMA Oncology, Baboudjian et al found no significant association between the use of 5α-reductase inhibitors (5-ARIs) and the risk of prostate cancer mortality.

As stated by the investigators, “Recently, several large, high-quality analyses have shown opposing results regarding the association between 5-ARI use and prostate cancer mortality.”

Study Details

The study involved a literature search through August 2022. Eligible studies were randomized clinical trials and prospective or retrospective cohort studies that included 5-ARI users and nonusers and analyzed prostate cancer mortality. The primary outcome measure was prostate cancer mortality among 5-ARI users vs nonusers.

Key Findings

A total of 11 studies met inclusion criteria, comprising 138,477 5-ARI users and 3,105,098 nonusers. Overall, no significant difference in risk for prostate cancer mortality was observed between 5-ARI users vs nonusers (adjusted hazard ratio [HR] = 1.04, 95% confidence interval [CI] = 0.80–1.35, P = .79).

In an analysis restricted to studies excluding patients with a diagnosis of prostate cancer at baseline, no significant difference in risk was observed for 5-ARI users vs nonusers (adjusted HR = 1.00, 95% CI = 0.60–1.67, P = .99). In an analysis of three studies that adjusted for prostate-specific antigen levels, a nonsignificant reduction in risk was observed for 5-ARI users vs nonusers (adjusted HR = 0.76, 95% CI = 0.57–1.03, P = .08).

The investigators concluded, “This systematic review and meta-analysis, which draws on 2 decades of epidemiologic literature and includes more than 3 million patients, found no statistically significant association between 5-ARI use and prostate cancer mortality but provides important data to inform clinical care.”

Michael Baboudjian, MD, of the Department of Urology, APHM, North Academic Hospital, Marseille, France, is the corresponding author for the JAMA Oncology article.

Disclosure: For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.