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Comment & Response
October 2019

5α-Reductase Inhibitor Use in Patients With Prostate Cancer

Author Affiliations
  • 1CHRISTUS Santa Rosa Hospital Medical Center, San Antonio, Texas
  • 2Fred Hutchinson Cancer Research Center, Seattle, Washington
  • 3Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Washington, DC
JAMA Intern Med. 2019;179(10):1440. doi:10.1001/jamainternmed.2019.3626

To the Editor Interpretation of observational studies is challenging when results are different from randomized trials.1 The recently published report by Sarkar and colleagues2 illustrates this challenge. A retrospective cohort of patients diagnosed with prostate cancer between 2001 and 2005 was described, and it was found that the use of 5-α reductase inhibitors (5-ARIs) was associated with a delayed diagnosis and a 39% increase in prostate cancer mortality. Initially, this conclusion seems at variance with the follow-up report of the randomized Prostate Cancer Prevention Trial, which showed no increase in prostate cancer mortality in men receiving finasteride compared with placebo.3

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