5-Alpha Reductase Inhibitors and Prostate Cancer Mortality among Men with Regular Access to Screening and Health Care.
5-Alpha Reductase Inhibitors and Prostate Cancer Mortality among Men with Regular Access to Screening and Health Care.
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DOI：
10.1158/1055-9965.epi-21-1234
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发表时间：
2022-07-01
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5-alpha还原酶抑制剂（5-ARI）的使用如何影响前列腺癌死亡率尚不清楚。本研究的目的是确定定期接受医疗保健的男性服用5-阿里斯是否会增加前列腺癌的死亡率。我们在卫生专业人员随访研究中进行了两项分析，研究了通过两年期问卷调查确定的5-ARI使用情况和前列腺癌。一项队列分析跟踪了1996年至2017年1月38，037名无癌症男性的前列腺癌发病率和2019年1月的死亡率。一项仅病例分析跟踪了4，383名患有局部/局部晚期前列腺癌的男性在类似时期的死亡率。计算前列腺癌发病率和死亡率的风险比（HR）和95%置信区间。使用5-阿里斯的男性接受了更多的PSA检测、前列腺检查和活检。在超过20年的随访中，509名男性发生了致命性疾病（转移或前列腺癌死亡）。在最初未患前列腺癌的男性中，5-ARI的使用与致死性疾病的发生无关（HR 1.02，0.71 - 1.46），但与总体和局部疾病的发生率降低相关（HR 0.71，0.60 - 0.83）。在诊断为前列腺癌的男性中，5-ARI的使用与癌症特异性（HR 0.78，0.48 - 1.27）或总生存率（HR 0.88，0.72 - 1.07）之间没有相关性。使用5-阿里斯的男性被诊断为低风险前列腺癌的可能性较小，而不会增加致命性前列腺癌或诊断后癌症特异性死亡的长期风险。我们的研究结果提供的证据表明，5-ARI的使用是安全的前列腺癌的死亡率在正常的医疗服务的背景下。
How 5-alpha reductase inhibitor (5-ARI) use influences prostate cancer mortality is unclear. The objective of this study was to determine whether men taking 5-ARIs with regular healthcare access have increased prostate cancer mortality. We undertook two analyses in the Health Professionals Follow-up Study examining 5-ARI use, determined by biennial questionnaires, and prostate cancer. A cohort analysis followed 38,037 cancer-free men for prostate cancer incidence from 1996 through January 2017 and mortality through January 2019. A case-only analysis followed 4,383 men with localized/locally advanced prostate cancer for mortality over a similar period. Hazard ratios (HR) and 95% confidence intervals were calculated for prostate cancer incidence and mortality. Men using 5-ARIs underwent more PSA testing, prostate exams and biopsies. Over 20 years of follow-up, 509 men developed lethal disease (metastases or prostate cancer death). Among men initially free from prostate cancer, 5-ARI use was not associated with developing lethal disease (HR 1.02, 0.71–1.46), but was associated with reduced rates of overall and localized disease (HR 0.71, 0.60–0.83). Among men diagnosed with prostate cancer, there was no association between 5-ARI use and cancer-specific (HR 0.78, 0.48–1.27) or overall survival (HR 0.88, 0.72–1.07). Men using 5-ARIs were less likely to be diagnosed with low-risk prostate cancer, without increasing long-term risk of lethal prostate cancer or cancer-specific death after diagnosis. Our results provide evidence that 5-ARI use is safe with respect to prostate cancer mortality in the context of regular healthcare access.