The Role of 5α-Reductase Inhibitors (5-ARIs) in Prostate Cancer Chemoprevention

  • David Margel
  • Neil Fleshner


Prostate cancer, due to its high prevalence and long latency period, is an ideal candidate for prevention. Considerable effort has been placed on prevention strategies utilizing 5α-reductase inhibitors (5-ARIs). In this chapter, we will review the rationale and key studies examining the role of these drugs in primary and secondary prevention of prostate cancer.


Prostate Cancer Gleason Score Active Surveillance Prostate Volume Pathologic Progression 
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  1. 1.
    Crook JM, Gomez-Iturriaga A, Wallace K, Ma C, Fung S, Alibhai S, Jewett M, Fleshner N. Comparison of health-related quality of life 5 years after SPIRIT: surgical prostatectomy versus interstitial radiation intervention trial. J Clin Oncol. 2011;29:362–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med. 2008;358(12):1250–61.PubMedCrossRefGoogle Scholar
  3. 3.
    Garos S, Kluck A, Aronoff D. Prostate cancer patients and their partners: differences in satisfaction indices and psychological variables. J Sex Med. 2007;4(5):1394–403.PubMedCrossRefGoogle Scholar
  4. 4.
    Nelson WG, De Marzo AM, Isaacs WB. Prostate cancer. N Engl J Med. 2003;349:366–81.PubMedCrossRefGoogle Scholar
  5. 5.
    Thomas LN, Lazier CB, Gupta R, et al. Differential alterations in 5alpha-reductase type 1 and type 2 levels during development and progression of prostate cancer. Prostate. 2005;63:231–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Clark RV, Hermann DJ, Cunningham GR, Wilson TH, Morrill BB, Hobbs S. Marked suppression of dihydrotestosterone in men with benign prostatic hyperplasia by dutasteride, a dual 5alpha-reductase inhibitor. J Clin Endocrinol Metab. 2004;89:2179–84.PubMedCrossRefGoogle Scholar
  7. 7.
    Sakr WA, Grignon DJ, Crissman JD, et al. High grade prostatic intraepithelial neoplasia (hgpin) and prostatic adenocarcinoma between the ages of 20–69: an autopsy study of 249 cases. In Vivo. 1994;8:439–43.PubMedGoogle Scholar
  8. 8.
    Thompson IM, et al. The influence of finasteride on the development of prostate cancer. N Engl J Med. 2003;349:215–49.PubMedCrossRefGoogle Scholar
  9. 9.
    Wilt T, MacDonald R, Hagerty K, et al. 5-α reductase inhibitors for prostate cancer prevention. Cochrane Database Syst Rev. 2008; 2: Art no.CD007091.Google Scholar
  10. 10.
    Lucia MS, Epstein JI, Goodman PJ, et al. Finasteride and high-grade prostate cancer in the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2007;99:1375–83.PubMedCrossRefGoogle Scholar
  11. 11.
    Kaplan S, Garvin D, Gilhooly P, et al. Impact of baseline symptom severity on future risk of benign prostatic hyperplasia-related outcomes and long term response to finasteride: The Pless Study Group. Urology. 2000;56:610–6.PubMedCrossRefGoogle Scholar
  12. 12.
    McConnell JD, Roehrborn CG, Bautista OM, et al. The long-term effect of doxazosin, finasteride, and combination therapy on the clinical progression of benign prostatic hyperplasia. N Engl J Med. 2003;349:2387–98.PubMedCrossRefGoogle Scholar
  13. 13.
    Cohen YC, Liu KS, Heyden NL, et al. Detection bias due to the effect of finasteride on prostate volume: a modeling approach for analysis of the Prostate Cancer Prevention Trial. J Natl Cancer Inst. 2007;99:1366–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Talcott JA. Rebalancing ratios and improving impressions: later thoughts from the prostate cancer prevention trial investigators. J Clin Oncol. 2005;23:7388–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Thompson IM, Chi C, Ankerst DP, et al. Effect of finasteride on the sensitivity of PSA for detecting prostate cancer. J Natl Cancer Inst. 2006;98(16):1128–33.PubMedCrossRefGoogle Scholar
  16. 16.
    Andriole GL, et al. Effect of dutasteride on the risk of prostate cancer. N Engl J Med. 2010;362:1192–202.PubMedCrossRefGoogle Scholar
  17. 17.
    Kramer BS, Hagerty KL, Justman S, et al. Use of 5-alpha–reductase inhibitors for prostate cancer chemoprevention: American Society of Clinical Oncology/American Urological Association 2008 Clinical Practice Guideline. J Clin Oncol. 2009;27:1502–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Finelli A, et al. Impact of 5a-reductase inhibitors on men followed by active surveillance for prostate cancer. Eur Urol. 2011;59:509–14.PubMedCrossRefGoogle Scholar
  19. 19.
    Fleshner N, Gomella LG, Cookson MS, Finelli A, Evans A, Taneja SS, Lucia MS, Wolford E, Somerville MC, Rittmaster R, REDEEM Study Group. Delay in the progression of low-risk prostate cancer: rationale and design of the Reduction by Dutasteride of Clinical Progression Events in Expectant Management (REDEEM) trial. Contemp Clin Trials. 2007;28(6):763–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Fleshner N, Lucia MS, Melich K, Nandy I, Black L, Rittmaster R. Dutasteride reduces prostate cancer progression and cancer diagnosis on re-biopsy in the REDEEM active surveillance study. Abstract SUO. 2010.Google Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Division of Urology, Department of Surgical OncologyPrincess Margaret Hospital, University Health NetworkTorontoCanada

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