5-Alpha-Reductase Inhibition as a Secondary Preventive Strategy

Chapter
First Online:
Part of the Current Clinical Urology book series (CCU)

Abstract

5-Alpha-reductase inhibitors (5-ARIs) block the conversion of testosterone to dihydrotestosterone, thereby reducing prostate volume and prostate-specific antigen (PSA). There is evidence that its use may also deter prostate cancer tumor growth. In large multinational randomized controlled trials (RCTs), 5-ARIs have been demonstrated to reduce prostate diagnosis by 25 %. There is observational data suggesting that for men with low-risk, localized prostate cancer on active surveillance, 5-ARI use prevents disease progression and clinical interventions. In a North American RCT, the ability of dutasteride to prevent prostate cancer progression was tested against placebo (composite measure of clinical and pathological progression), and 10 % fewer patients in the treatment group had a progression event. Specialty organizations are mixed in their endorsement of 5-ARIs for secondary prevention of prostate cancer for men on active surveillance. Ongoing studies are exploring the visible tumor change on multiparametric magnetic resonance imaging (mpMRI) for men using dutasteride versus placebo on active surveillance.

Keywords

Prostate cancer Active surveillance 5-Alpha-reductase inhibitors 5-ARI Secondary prevention 
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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Urologic OncologyUniversity of TorontoTorontoCanada
  2. 2.Division of Urology, Department of Surgical OncologyUniversity Health Network, Princess Margaret Cancer CentreTorontoCanada
  3. 3.Division of Urology/Uro-Oncology, Department of Surgical OncologyPrincess Margaret Cancer CentreTorontoCanada

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