5α-Reductase Inhibitors and Chemoprevention: The PCPT and Beyond

The document reviewed the role of 5α-reductase inhibitors (5-ARIs) in prostate cancer chemoprevention, particularly through studies like the Prostate Cancer Prevention Trial (PCPT) with 18,800 men, which showed a 24.8% reduction in prostate cancer prevalence with finasteride over 7 years. However, there was a noted increase in high-Gleason score tumors in the finasteride group. Other studies, such as those with dutasteride, also suggested potential benefits in reducing prostate cancer risk, though results varied. The document concluded that while 5-ARIs could lower prostate cancer risk and improve benign prostatic hyperplasia (BPH) outcomes, the increased detection of high-grade tumors required further research. It also discussed the impact of 5-ARIs on prostate cancer detection and emphasized the need for pharmacoeconomic evaluations to determine the best strategies for chemoprevention, particularly whether to focus on high-risk individuals or apply resources more broadly.