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5-Alpha reductase inhibitor use and prostate cancer survival in the Finnish Prostate Cancer Screening Trial.

https://arctichealth.org/en/permalink/ahliterature275383
Source
Int J Cancer. 2016 Jun 15;138(12):2820-8
Publication Type
Article
Date
Jun-15-2016
Author
Teemu J Murtola
Elina K Karppa
Kimmo Taari
Kirsi Talala
Teuvo L J Tammela
Anssi Auvinen
Source
Int J Cancer. 2016 Jun 15;138(12):2820-8
Date
Jun-15-2016
Language
English
Publication Type
Article
Keywords
5-alpha Reductase Inhibitors - therapeutic use
Aged
Antineoplastic Agents - therapeutic use
Early Detection of Cancer
Finland - epidemiology
Humans
Kaplan-Meier Estimate
Male
Mass Screening
Middle Aged
Multivariate Analysis
Proportional Hazards Models
Prostatic Neoplasms - diagnosis - drug therapy - mortality
Abstract
Randomized clinical trials have shown that use of 5a-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.
PubMed ID
26804670 View in PubMed
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