Sarkar RR, et al. - In this population-based cohort study with 80,875 men with prostate cancer, researchers tested the premise that 5α-reductase inhibitor (5-ARI) use in a prediagnostic setting was associated with delayed diagnosis, more advanced diagnostic disease, and a greater risk of prostate cancer-specific mortality, and all-cause mortality vs the use of other or no prostate-specific antigen (PSA)-decreasing drugs. In men with prostate cancer, delayed diagnosis and worse cancer-specific outcomes are linked to prediagnostic use of 5-ARIs. These data highlight an ongoing need to raise awareness of 5-ARI-induced suppression of PSA, set clear guidelines for early detection of prostate cancer, and motivate system-based practices to facilitate optimal care for men using 5-ARIs.