Mucci LA, Pernar CH, Rencsok E, et al. - Given the Prostate Cancer Prevention Trial (PCPT) has demonstrated excess risk of high-grade prostate cancer in men randomized to finasteride, this finding raised concerns that a chemoprevention benefit would be offset by raised mortality, and moreover, two 2019 publications showed contrasting results if 5-ARIs raised prostate cancer mortality, and considering that no excess prostate cancer mortality was reported in PCPT but 5-ARI use has been shown to be related to later stage at diagnosis and 39% higher prostate cancer mortality risk in a VA study, researchers tried to address this conflicting evidence by analyzing men with regular access to healthcare and screening. They conducted two parallel analyses in the Health Professionals Follow-up Study. Findings align with PCPT and revealed that 5-ARI was neither associated with excess risk of lethal prostate cancer, or higher stage at diagnosis, nor with excess mortality post-diagnosis. More interactions with healthcare were reported in men taking 5-ARIs, possibly resulting in higher quality care. This contrasts with the VA study where men receiving 5-ARIs were diagnosed later because of suppressed PSA and experienced worse survival. These revelations highlight that real-world data holds significance for framing the benefits and risks related to 5-ARIs.