• Antonio Finelli, Greg Trottier, Nathan Lawrentschuk, Robert Sowerby, Alexandre R Zlotta, Lenny Radomski, Narhari Timilshina, Andrew Evans, Theodorus H van der Kwast, Ants Toi, Micheal A S Jewett, John Trachtenberg, and Neil E Fleshner.
• Princess Margaret Hospital, University Health Network, University of Toronto, Ontario, Canada. antonio.finelli@uhn.on.ca
• Eur. Urol. 2011 Apr 1; 59 (4): 509-14.

BackgroundIn two large randomized controlled trials, 5α-reductase inhibitors (5-ARIs) were shown to prevent prostate cancer. No prior work had shown the effect of 5-ARIs on those already diagnosed with low-risk prostate cancer.ObjectiveOur aim was to determine the effect of 5-ARIs on pathologic progression in men on active surveillance.Design, Setting, And ParticipantsWe conducted a single-institution retrospective cohort study comparing men taking a 5-ARI versus no 5-ARI while on active surveillance for prostate cancer.MeasurementsPathologic progression was evaluated and defined as Gleason score >6, maximum core involvement >50%, or more than three cores positive on a follow-up prostate biopsy. Kaplan-Meier analyses were conducted along with multivariable Cox proportional hazard regression modeling for predictors of pathologic progression.Results And LimitationsA total of 288 men on active surveillance met the inclusion criteria. The median follow-up was 38.5 mo (interquartile range: 23.6-59.4) with 93 men (32%) experiencing pathologic progression and 96 men (33%) abandoning active surveillance. Men taking a 5-ARI experienced a lower rate of pathologic progression (18.6% vs 36.7%; p=0.004) and were less likely to abandon active surveillance (20% vs 37.6%; p=0.006). On multivariable Cox proportional hazards analysis, lack of 5-ARI use was most strongly associated with pathologic progression (hazard ratio: 2.91; 95% confidence interval, 1.5-5.6). The main study limitation was the retrospective design and variable duration of 5-ARI therapy.ConclusionsThe 5-ARIs were associated with a significantly lower rate of pathologic progression and abandonment of active surveillance.Crown Copyright © 2011. Published by Elsevier B.V. All rights reserved.

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