■5-α-还原酶抑制剂(5-ARIs)被批准用于治疗良性前列腺增生(BPH),并已发现可将前列腺癌(PCa)风险降低25%。然而,试验还显示5-ARIs与高级别PCa相关.5-ARIs是否会增加PCa诊断患者的死亡率尚不清楚。
■确定与非使用者相比,服用5-ARIs的个体出现的临床局部PCa的长期结果。
■这项基于人群的队列研究于2003年1月至2017年10月之间进行。符合条件的参与者是安大略省65岁或以上的男性,加拿大,他从安大略省卫生管理数据库中开发了具有完整病理学抽象的临床局部PCa。数据分析发生在2017年11月至2022年11月。
■PCa诊断前5-ARIs。
■主要结局是总死亡率和PCa特异性死亡率。使用具有逆概率治疗权重(IPTW)的原因特异性风险模型来检查5-ARI使用与死亡率结果的关联。基于诊断前5-ARI使用的敏感性分析,格里森得分,合并症,5-ARI指征,前列腺特异性抗原建模,并使用他汀类药物.
■该队列包括19938例PCa患者。其中,2112(10.6%;年龄中位数,74[70-79]岁)是5-ARI用户和17826(89.4%;中位[IQR]年龄,71[68-76]年)是非用户。在8.96(6.28-12.17)年的中位数(IQR)随访期间,6053(30.4%)死亡,包括来自PCa的1047(5.3%)。在粗分析中,5-ARI的使用似乎与总体死亡率和PCa特异性死亡率的增加有关;然而,在IPTW之后,5-ARI使用与总死亡率无关(风险比,0.98;95%CI,0.90-1.07;P=.77)或PCa特异性死亡率(危险比,1.02;95%CI,0.83-1.25;P=.84)。
■在这项基于人群的队列研究中,在PCa诊断前使用5-ARI,包括长期随访和临床病理细节,诊断前使用5-ARI与PCa特异性或全因死亡率无关.这项研究为在PCa诊断前使用5-ARIs的患者提供了令人放心的安全性数据。
UNASSIGNED: 5-alpha-reductase-inhibitors (5-ARIs) are approved for treating benign prostatic hyperplasia (BPH) and have been found to reduce prostate cancer (PCa) risk by 25%. However, trials also have shown 5-ARIs to be associated with high-grade PCa. Whether 5-ARIs increase mortality among those with a diagnosis of PCa remains unclear.
UNASSIGNED: To determine long-term outcomes of clinically localized PCa arising in individuals taking 5-ARIs compared with nonusers.
UNASSIGNED: This population-based cohort study was conducted between January 2003 and October 2017. Eligible participants were men aged 65 years or older in Ontario, Canada, who developed clinically localized PCa with complete pathological abstraction from the Ontario Health Administrative Databases. Data analysis occurred from November 2017 to November 2022.
UNASSIGNED: 5-ARIs before PCa diagnosis.
UNASSIGNED: The primary outcomes were overall mortality and PCa-specific mortality. Cause-specific hazard models with inverse probability treatment weights (IPTW) were used to examine associations of 5-ARI use with mortality outcomes. Sensitivity analyses based on prediagnostic 5-ARI use, Gleason score, comorbidity, 5-ARI indication, prostate-specific antigen modeling, and statin use were also performed.
UNASSIGNED: The cohort included 19 938 patients with PCa. Of these, 2112 (10.6%; median [IQR] age, 74 [70-79] years) were 5-ARI users and 17 826 (89.4%; median [IQR] age, 71 [68-76] years) were nonusers. During a median (IQR) follow-up of 8.96 (6.28-12.17) years, 6053 (30.4%) died, including 1047 (5.3%) from PCa. 5-ARI use appeared to be associated with increased overall and PCa specific mortality in crude analyses; however, after IPTW, 5-ARI use was not associated with overall mortality (hazard ratio, 0.98; 95% CI, 0.90-1.07; P = .77) or PCa-specific mortality (hazard ratio, 1.02; 95% CI, 0.83-1.25; P = .84).
UNASSIGNED: In this population-based cohort study of 5-ARI use prior to PCa diagnosis including long-term follow-up and clinicopathologic details, prediagnostic 5-ARI use was not associated with PCa-specific or all-cause mortality. This study offers reassuring safety data for patients using 5-ARIs before PCa diagnosis for both BPH and chemopreventive reasons.