Influence of 5-Alpha Reductase Inhibitors on PI-RADS Scores and Prostate Cancer Detection: A Systematic Review and Meta-Analysis.

Background: The impact of 5-alpha reductase inhibitors (5-ARIs) on Prostate Imaging Reporting and Data System (PI-RADS) tumor classifications and prostate cancer (PCa) detection were reviewed and analyzed.

Method: A comprehensive systematic review and meta-analysis were conducted by evaluating published studies examining the influence of 5-ARIs on PI-RADS lesions and PCa detection. The Web of Science, PubMed, and Embase databases were accessed for relevant study retrieval. Statistical analyses were performed through the use of STATA v.16.0.

Results: Seven studies, comprising 12,132 participants, were included. Compared to men who had not received 5-ARIs, those exposed to 5-ARIs exhibited no significant differences in PCa diagnosis (OR 0.97, 95% CI 0.86-1.08; p = 0.55) or clinically significant PCa (csPCa) diagnosis (OR 1.01, 95% CI 0.89-1.16; p = 0.85). Further subgroup analyses demonstrated that 5-ARI-exposed men had comparable PCa diagnosis in PI-RADS 3 (OR 0.85, 95% CI 0.65-1.12; p = 0.25), PI-RADS 4 (OR 1.01, 95% CI 0.85-1.21; p = 0.84), and PI-RADS 5 (OR 1.01, 95% CI 0.81-1.26; p = 0.87) groups relative to 5-ARI-naïve men.

Conclusions: These findings suggest that 5-ARIs do not significantly alter PI-RADS lesion distribution or impact PCa and csPCa diagnosis. Consequently, exposure to 5-ARIs should not influence MRI-based diagnostic approaches in patients with suspected PCa.