5-Alpha Reductase Inhibitor Use and Prostate Cancer Prevention: A Victim of the Times?

Vaselkiv and colleagues present strong evidence of the long-term safety of 5-alpha reductase inhibitor (5-ARI) use. They demonstrated no association with developing advanced prostate cancer, nor dying of prostate cancer. This commentary covers the strengths and weaknesses of the article, and highlights the long and vacillating journey 5-ARIs and prostate cancer prevention have traveled. As 5-ARIs preferentially prevent low-grade prostate cancer, a fact confirmed in the study by Vaselkiv and colleagues, this commentary highlights how 5-ARI chemoprevention may be irrelevant now. With increasing use of active surveillance for low-grade prostate cancers found, and prebiopsy MRI and biomarkers shifting focus to only find those clinically significant cancers, it maybe that 5-ARIs are a victim of the times in their chemoprevention role. See related article by Vaselkiv et al., p. 1460.