Dai C, et al. – The physicians conducted this work to determine the impact of 5(alpha)–reductase inhibitors (5–ARI) on disease reclassification in men with prostate cancer optimally selected for active surveillance (AS). Among the cohort of men on AS, It was showed that 5–ARI use was not correlated with a significant difference in grade reclassification over time.

Methods

• Between 2002–2015, a retrospective review identified 635 patients on AS.
• Thereafter, patients with favorable cancer features on repeat biopsy, characterized as absence of Gleason upgrading, were enrolled in the cohort.
• They stratified patients by those who did or did not receive finasteride/dutasteride within 1 year of diagnosis.
• The preliminary outcome was grade reclassification, characterized as any increase in Gleason score or predominant Gleason pattern on a subsequent biopsy, and was assessed by multivariable Cox proportional hazards regression analysis.

Results

• At diagnosis, 371 patients met inclusion criteria, of whom 70 (19%) were started on 5–ARIs within 12 months.
• In this study, median time on AS was 53 vs. 35 months for men on 5–ARI vs. not on 5–ARI, respectively (p<0.01).
• Men on 5–ARI received 5–ARIs for a median of 23 months (IQR 6–37).
• No significant difference was observed in grade reclassification with 5–ARI use in patients overall or in the very low/low–risk subset.
• The overall percentage of patients experiencing grade reclassification was similar (13% vs. 14%, p=0.75).
• The data showed that 5–ARI use was not significantly correlated with grade reclassification (HR 0.80, CI 0.31–1.80; p=0.62) after adjusting for baseline clinicopathologic features.
• Moreover, no difference was found in adverse features on radical prostatectomy specimens in treated patients (p=0.36).