5-Alpha reductase inhibitors in active surveillance

Purpose of reviewActive surveillance is now one of the recommended treatment options for low-risk prostate cancer (PCa). However, about 10-30% of men on active surveillance will progress and require definitive therapy. In this review, we examine the role of 5-alpha reductase inhibitors (5-ARIs) in secondary prevention among men with low-risk PCa who opted to be managed by active surveillance.Recent findingsThree retrospective studies and one randomized controlled trial have evaluated the role of 5-ARIs in preventing clinical progression among men followed by active surveillance. These studies largely support the role of 5-ARIs for secondary chemoprevention, although the drugs do not have an indication for this setting.Summary5-ARIs have been shown to play an important role in preventing clinical progression among men with low-risk PCa on active surveillance. However, in light of the US Food and Drug Administration recommendation against 5-ARIs for primary chemoprevention, these findings should be interpreted with caution. Patients should be made aware of this warning label before starting the drug.