Impact of 5α-reductase inhibitors on disease reclassification among men on active surveillance for localized prostate cancer with favorable features.

Citation:
Dai, C., V. Ganesan, J. Zabell, Y. A. Nyame, N. Almassi, D. J. Greene, D. Hettel, C. Reichard, S. C. Haywood, H. Arora, et al., "Impact of 5α-reductase inhibitors on disease reclassification among men on active surveillance for localized prostate cancer with favorable features.", The Journal of urology, 2017 Aug 05.

Abstract:

PURPOSE: To determine the effect of 5α-reductase inhibitors (5-ARI) on disease reclassification in men with prostate cancer optimally selected for active surveillance (AS).

MATERIALS AND METHODS: A retrospective review identified 635 patients on AS between 2002-2015. Patients with favorable cancer features on repeat biopsy, defined as absence of Gleason upgrading, were included in the cohort. Patients were stratified by those who did or did not receive finasteride/dutasteride within 1 year of diagnosis. The primary endpoint was grade reclassification, defined as any increase in Gleason score or predominant Gleason pattern on a subsequent biopsy, and was assessed by multivariable Cox proportional hazards regression analysis.

RESULTS: At diagnosis, 371 patients met inclusion criteria, of whom 70 (19%) were started on 5-ARIs within 12 months. Median time on AS was 53 vs. 35 months for men on 5-ARI vs. not on 5-ARI, respectively (p<0.01). Men on 5-ARI received 5-ARIs for a median of 23 months (IQR 6-37). On actuarial analysis, there was no significant difference in grade reclassification with 5-ARI use in patients overall or in the very low/low-risk subset. The overall percentage of patients experiencing grade reclassification was similar (13% vs. 14%, p=0.75). After adjusting for baseline clinicopathologic features, 5-ARI use was not significantly associated with grade reclassification (HR 0.80, CI 0.31-1.80; p=0.62). Furthermore, no difference in adverse features on radical prostatectomy specimens was observed in treated patients (p=0.36).

CONCLUSIONS: Among our cohort of men on AS, 5-ARI use was not associated with a significant difference in grade reclassification over time.