Kearns JT, et al. - In the Canary Prostate Active Surveillance Study (PASS), researchers ascertained the correlation of five-alpha reductase inhibitors (5-ARIs) use with risk of reclassification. Results of this study did not reveal a link between continued 5-ARI use after initial prostate cancer diagnosis with risk of reclassification on active surveillance (AS).

Methods

• Authors enrolled the participants in the multicenter PASS between 2008-2016.
• Current or never 5-ARI user, Gleason ≤ 3+4 PCa at diagnosis, < 34% core involvement ratio at diagnosis, and ≥ 1 surveillance biopsy were the inclusion criteria.
• They included 1,009 men (107 5-ARI users and 902 never users).
• They defined the reclassification as increase in Gleason score and/or increase in ratio of biopsy cores positive for cancer to ≥ 34%.
• Experts defined the adverse pathology at prostatectomy as Gleason ≥ 4+3 and/or non-organ-confined disease (pT3 or N1).

Results

• Between 5-ARI users and never 5-ARI users (HR 0.81, p=0.31), there was no difference in the risk of reclassification, as seen on multivariable analysis.
• Findings suggested a lower likelihood of 5-ARI users to undergo radical prostatectomy (RP) (8% vs 18%, p=0.01) or any definitive treatment (19% vs 24%, p=0.04).
• Results did not demonstrate any difference in the rate of adverse pathology between 5-ARI users and non-users at prostatectomy among participants who underwent RP (n=167).