Alpha male.

Do men treated with 5ɑ-reductase inhibitors (5-ARIs) have a lower risk of prostate cancer mortality? 5-ARIs, such as finasteride, inhibit the conversion of testosterone to the more potent dihydrotestosterone. In the Prostate Cancer Prevention Trial (PCPT), the use of 5-ARIs was associated with a reduced risk of prostate cancer. But it is unclear if 5-ARIs affect the risk of prostate cancer specific mortality (PCSM) with some studies suggesting that 5-ARIs may delay diagnosis and result in worse outcomes. This Swedish population-based cohort cohort study of nearly 350,000 men who underwent PSA screening with ~7.5% receiving two or more dispensations of a 5-ARI. Median 5-ARI exposure was 4.5 years. Adjusted multivariable survival analysis found that longer 5-ARI exposure was associated with a lower risk of PCSM. Of note, though, 5-ARI recipients also had more PSA tests and more prostate biopsies. | Bjornebo, JAMA Oncol 2022