title: 5-Alpha reductase inhibitor use and prostate cancer survival in the Finnish Prostate Cancer Screening Trial.
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.
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.|Department of Urology, Tampere University Hospital, Tampere, Finland.
authors.forename: Teemu J
authors.initials: TJ
authors.lastname: Murtola
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.
authors.forename: Elina K
authors.initials: EK
authors.lastname: Karppa
authors.affiliation: Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
authors.forename: Kimmo
authors.initials: K
authors.lastname: Taari
authors.affiliation: Finnish Cancer Registry, Helsinki, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Talala
authors.affiliation: School of Medicine, University of Tampere, Tampere, Finland.|Department of Urology, Tampere University Hospital, Tampere, Finland.
authors.forename: Teuvo L J
authors.initials: TL
authors.lastname: Tammela
authors.affiliation: School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Anssi
authors.initials: A
authors.lastname: Auvinen
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000627:therapeutic use*; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D055088:Early Detection of Cancer; D005387:Finland / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality
chemical_list: D058891:5-alpha Reductase Inhibitors; D000970:Antineoplastic Agents
keywords: 5-alpha reductase inhibitors; adrenergic alpha-blockers; prostate cancer; survival