ASCO/AUA guideline: Discuss 5-alpha-reductase inhibitors to reduce prostate cancer risk

February 26, 2009

Urologists and primary care physicians should discuss the use of 5-alpha-reductase inhibitors for prostate cancer prevention with men who have a PSA ?3.0 and who regularly are screened for prostate cancer and show no signs of the disease. That is the primary conclusion of a new joint guideline released by AUA and the American Society of Clinical Oncology.

Urologists and primary care physicians should discuss the use of 5-alpha-reductase inhibitors for prostate cancer prevention with men who have a PSA ≤3.0 and who regularly are screened for prostate cancer and show no signs of the disease. That is the primary conclusion of a new joint guideline released by AUA and the American Society of Clinical Oncology.

The guideline further suggests that men who already use 5-ARIs for other conditions consult their physician about continuing to use the drug for chemoprevention. 5-ARIs lower the level of the hormone dihydrotestosterone, which can contribute to the growth of prostate cancer.

“Although one in every six men in the United States will be diagnosed with prostate cancer, we are not recommending that all men take 5-ARIs,” said Barnett S. Kramer, MD, MPH, guideline panel co-chair and associate director for disease prevention at the National Institutes of Health. “However, we would encourage men to begin a dialogue with their doctor to determine if they could benefit from taking 5-ARIs to reduce their prostate cancer risk.”

The ASCO/AUA recommendations are based on evidence gathered from clinical trials, including the Prostate Cancer Prevention Trial, in which participants took a 5-ARI for 1 to 7 years. Data from the study showed an overall relative risk reduction of approximately 25% in most men who took the drug to prevent prostate cancer.

In conjunction with the guideline, ASCO developed a Decision Aid Tool that uses straightforward charts and diagrams to explain the risks and benefits of using 5-ARIs to patients and their families. One section encourages patients to discuss potential treatment decisions with their physician and family members.

The guideline will be published in upcoming issues of the Journal of Clinical Oncology and The Journal of Urology. In addition, the guideline, the Decision Aid Tool, and a corresponding patient guide will be available at ASCO’s patient web site, www.cancer.net.