Thakrar Dixa B, Douglas Ian J, Smeeth Liam, Bhaskaran Krishnan
London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
Wellcome Open Res. 2023 Jul 11;8:295. doi: 10.12688/wellcomeopenres.19566.1. eCollection 2023.
Five-alpha reductase inhibitors (5ARIs) are used in the management of benign prostatic hyperplasia (BPH). 5ARIs prevent the conversion of testosterone to dihydrotestosterone, which is important in prostate development. It has been suggested that 5ARIs can be used a chemopreventative agent for prostate cancer. The aim of this study was to assess the risk of prostate cancer associated with 5ARI use among men with BPH. Using Clinical Practice Research Datalink (CPRD) from 1992 to 2011 in UK, prostate cancer risk was retrospectively compared in men with a new diagnosis of BPH, with no history of prostate cancer who were treated with 5ARIs, to men treated with alpha blockers (ABs) and those given no pharmacological treatment. Incidence rate of prostate cancer was calculated by treatment group; the association between BPH treatment group and prostate cancer was estimated by a multivariate Cox model. 77,494 men with newly diagnosed BPH were included. The crude incidence rate of prostate cancer was 892.4 cases per 100,000 person-years amongst those treated with 5ARIs, compared with 1209.0 and 1542.9 in those treated with ABs and untreated individuals, respectively. The HR adjusted for potential confounders was 0.79 (0.72-0.86) for 5ARI vs ABs and 0.72 (0.66-0.79) for 5ARI vs untreated. After excluding the first year after BPH diagnosis, adjusted HRs attenuated to 0.87 (0.79-0.97) for 5ARI vs ABs and 0.97 (0.87-1.08) for 5ARI vs untreated. Among men diagnosed with BPH, we found evidence of lower risks of subsequent prostate cancer in those treated with 5ARIs, but this appeared to be driven by cases diagnosed within a year of BPH, possibly reflecting prevalent prostate cancers that were initially misdiagnosed. After excluding the first year after BPH diagnosis, there was little evidence of a reduced prostate cancer risk in those taking 5ARIs.
5α还原酶抑制剂（5ARIs）用于治疗良性前列腺增生（BPH）。5ARIs可阻止睾酮转化为双氢睾酮，这在前列腺发育过程中很重要。有人提出5ARIs可作为前列腺癌的化学预防剂。本研究的目的是评估BPH男性使用5ARIs后患前列腺癌的风险。利用英国1992年至2011年的临床实践研究数据链（CPRD），对新诊断为BPH、无前列腺癌病史且接受5ARIs治疗的男性与接受α受体阻滞剂（ABs）治疗的男性以及未接受药物治疗的男性的前列腺癌风险进行回顾性比较。按治疗组计算前列腺癌发病率；采用多变量Cox模型估计BPH治疗组与前列腺癌之间的关联。共纳入77494例新诊断为BPH的男性。接受5ARIs治疗的患者中，前列腺癌的粗发病率为每10万人年892.4例，而接受ABs治疗的患者和未接受治疗的患者分别为1209.0例和1542.9例。调整潜在混杂因素后，5ARIs与ABs相比的HR为0.79（0.72 - 0.86），5ARIs与未治疗组相比的HR为0.72（0.66 - 0.79）。排除BPH诊断后的第一年，5ARIs与ABs相比的调整后HR降至0.87（0.79 - 0.97），5ARIs与未治疗组相比的调整后HR为0.97（0.87 - 1.08）。在诊断为BPH的男性中，我们发现接受5ARIs治疗的患者后续患前列腺癌的风险较低，但这似乎是由BPH诊断后一年内确诊的病例驱动的，可能反映了最初被误诊的前列腺癌。排除BPH诊断后的第一年，几乎没有证据表明服用5ARIs的患者前列腺癌风险降低。
