Prostate cancer prevention with 5-alpha reductase inhibitors: Concepts and controversies

Purpose of review We review the concepts surrounding prostate cancer prevention strategies with 5-alpha reductase inhibitors (5-ARIs) and the controversies associated with their use. Recent findings Updated data have shown no increased risk of death from the diagnosis of higher risk cancer; however, 5-ARIs remain controversial and not approved for prostate cancer prevention. Summary The main theme of the review identifies the success of reducing insignificant prostate cancer and the controversy with the increased association of higher risk prostate cancer by approximately 20%. The reduction was shown to be most significant reduction in low-grade prostate cancer. The initial concern about 5-ARI use was that it could potentially increase high-risk prostate cancer leading to higher mortality in those men. Higher mortality has not been seen in follow-up data; however, 5-ARIs continue to have a black box warning and are not approved for prostate cancer prevention.