How Do 5-Alpha-Reductase Inhibitors Change PSA Density in Patients on Active Surveillance?

The study investigated the impact of 5-alpha-reductase inhibitors (5ARIs) on PSA Density (PSAD) in patients under active surveillance (AS) for prostate cancer. Data from 445 patients, including 47 who took 5ARIs, were analyzed. Results showed that while 5ARIs reduce PSAD, patients who progressed to GG2+ disease or required treatment had significantly higher PSADs compared to those who did not progress. Specifically, median PSADs were 0.139 for those progressing to GG2+ and 0.190 for those needing treatment, versus 0.074 for non-progressors. The study suggests that 5ARIs may help identify patients with clinically significant disease, though further research is needed to establish PSAD cutoffs for biopsy decisions in patients on 5ARIs.