title: 5-Alpha Reductase Inhibitors and the Risk of Prostate Cancer Mortality in Men Treated for Benign Prostatic Hyperplasia.
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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine, University of Michigan, Ann Arbor, MI; Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. Electronic address: lwallner@med.umich.edu.
authors.forename: Lauren P
authors.initials: LP
authors.lastname: Wallner
authors.affiliation: Worldwide Epidemiology, GlaxoSmithKline, Collegeville, PA.
authors.forename: Julia R
authors.initials: JR
authors.lastname: DiBello
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Bonnie H
authors.initials: BH
authors.lastname: Li
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Van Den Eeden
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, ORG.
authors.forename: Sheila
authors.initials: S
authors.lastname: Weinmann
authors.affiliation: Institute for Health Research, Kaiser Permanente Colorado, Denver, CO.
authors.forename: Debra P
authors.initials: DP
authors.lastname: Ritzwoller
authors.affiliation: Real World Evidence, Janssen, Philadelphia, PA.
authors.forename: Jill E
authors.initials: JE
authors.lastname: Abell
authors.affiliation: Department of Biostatistical Science, Wake Forest University, Winston-Salem, NC.
authors.forename: Ralph
authors.initials: R
authors.lastname: D'Agostino
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Loo
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: David S
authors.initials: DS
authors.lastname: Aaronson
authors.affiliation: Center for Health Research, Kaiser Permanente Northwest, Portland, ORG.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Richert-Boe
authors.affiliation: Temple University, Philadelphia, PA; Institute of Medicine, Washington, DC.
authors.forename: Ralph I
authors.initials: RI
authors.lastname: Horwitz
authors.affiliation: Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Jacobsen
mesh_terms: D058891:5-alpha Reductase Inhibitors / Q000009:adverse effects*; D000317:Adrenergic alpha-Antagonists / Q000009:adverse effects; D000368:Aged; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011470:Prostatic Hyperplasia / Q000188:drug therapy*; D011471:Prostatic Neoplasms / Q000139:chemically induced* / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D058891:5-alpha Reductase Inhibitors; D000317:Adrenergic alpha-Antagonists