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5-alpha-Reductase inhibitors for prostate cancer chemoprevention: an updated Cochrane systematic review.

Author(s): Wilt TJ, Macdonald R, Hagerty K, Schellhammer P, Tacklind J, Somerfield MR, Kramer BS

Affiliation(s): Minneapolis VA Center for Chronic Disease Outcomes Research, Minneapolis, MN 55417, USA. tim.wilt@va.gov

Publication date & source: 2010-11, BJU Int., 106(10):1444-51.

Publication type: Meta-Analysis; Research Support, Non-U.S. Gov't; Review

OBJECTIVE: * To estimate the benefits and harms of 5-alpha-reductase inhibitors (5-alpha-RIs) in preventing prostate cancer. MATERIALS AND METHODS: * We searched MEDLINE and the Cochrane Collaboration Library through June 2010 to identify randomized trials. * We included articles if they examined 5-alpha-RI vs control, were >/= 1 year in duration and provided clinical outcomes. * Our primary outcome was prostate cancer period-prevalence 'for-cause'. RESULTS: * Eight studies met inclusion criteria but only the Prostate Cancer Prevention Trial and the Reduction by Dutasteride of Prostate Cancer Events were designed to assess the impact of 5-alpha-RIs on prostate cancer period-prevalence. The mean age of enrolees was 64 years, 92% were White, and mean PSA level was 3.1 ng/mL. For-cause prostate cancers comprised 54% of all cancers detected in placebo-controlled studies. * Compared with placebo, 5-alpha-RI resulted in a 25% relative risk (RR) reduction in prostate cancers detected for-cause [RR 0.75, 95% confidence interval (CI) 0.67-0.83; 1.4% absolute risk reduction (3.5% vs 4.9%)]. One BPH trial reported that the risk of prostate cancers detected for-cause was significantly reduced with dutasteride and combined dutasteride plus tamsulosin compared with tamsulosin monotherapy. * Six trials vs placebo assessed prostate cancers detected overall. There was a 26% RR reduction favouring 5-alpha-RI [RR 0.74, 95% CI 0.55-1.00; 2.9% absolute risk reduction (6.3% vs 9.2%)]. There were reductions across categories of age, race and family history of prostate cancer. * One placebo-controlled trial of men that investigators considered at greater risk for prostate cancer (based on age, elevated PSA level and having a previous suspicion of prostate cancer leading to a prostate biopsy) reported that dutasteride did not reduce prostate cancers detected for-cause based on needle-biopsy but did reduce risk of overall incident prostate cancer detected by biopsy by 23%[RR 0.77, 95% CI 0.70-0.85; absolute reduction 16.1% vs 20.8%]. There were reductions across age, family history of prostate cancer, PSA level, and prostate volume subgroups. * Incidences of erectile dysfunction, ejaculate volume, decreased libido, and gynaecomastia were greater with 5-alpha-RI vs placebo. CONCLUSIONS: * 5-alpha-RIs reduce the risk of being diagnosed with prostate cancer among men who are screened regularly for prostate cancer. * Information is inadequate to assess the effect of 5-alpha-RIs on prostate cancer or all-cause mortality. * 5-alpha-RIs increase sexual and erectile dysfunction. (c) 2010 THE AUTHORS; BJU INTERNATIONAL (c) 2010 BJU INTERNATIONAL.

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