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Continued 5 -Reductase Inhibitor Use after Prostate Cancer Diagnosis and the Risk of Reclassification and Adverse Pathological Outcomes in the PASS.

Kearns JT, Faino AV, Schenk JM, Newcomb LF, Brooks JD, Carroll PR, Dash A, Ellis WJ, Fabrizio M, Gleave ME, Morgan TM, Nelson PS, Thompson IM, Wagner A, Zheng Y, Lin DW. Continued 5 -Reductase Inhibitor Use after Prostate Cancer Diagnosis and the Risk of Reclassification and Adverse Pathological Outcomes in the PASS. The Journal of urology. 2019 Jan 1; 201(1):106-111.

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PURPOSE: Outcomes in patients who enroll in active surveillance programs for prostate cancer while receiving 5 -reductase inhibitors have not been well defined. We sought to determine the association of 5 -reductase inhibitor use with the risk of reclassification in the PASS (Canary Prostate Active Surveillance Study). MATERIALS AND METHODS: Participants in the multicenter PASS were enrolled between 2008 and 2016. Study inclusion criteria were current or never 5 -reductase inhibitors use, Gleason score 3 + 4 or less prostate cancer at diagnosis, less than a 34% core involvement ratio at diagnosis and 1 or more surveillance biopsies. Included in study were 1,009 men, including 107 on 5 -reductase inhibitors and 902 who had never received 5 -reductase inhibitors. Reclassification was defined as increase in the Gleason score and/or an increase to 34% or greater in the ratio of biopsy cores positive for cancer. Adverse pathology at prostatectomy was defined as Gleason 4 + 3 or greater and/or nonorgan confined disease (pT3 or N1). RESULTS: On multivariable analysis there was no difference in reclassification between men who had received and those who had never received 5 -reductase inhibitors (HR 0.81, p = 0.31). Patients who had received 5 -reductase inhibitors were less likely to undergo radical prostatectomy (8% vs 18%, p = 0.01) or any definitive treatment (19% vs 24%, p = 0.04). In the 167 participants who underwent radical prostatectomy there was no suggestion of a difference in the rate of adverse pathology findings at prostatectomy between 5 -reductase inhibitor users and nonusers. CONCLUSIONS: Continued 5 -reductase inhibitor use after an initial diagnosis of prostate cancer was not associated with the risk of reclassification on active surveillance in men in the PASS cohort.

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