In Reply We would like to thank Gann for his important perspective on this topic and for his interest in our study.1 In his letter, Gann notes an important modeling article that takes the size of the prostate into account when determining the effect of use of a 5-α reductase inhibitor (5-ARI) on the development of low-grade and high-grade prostate cancers.2 There is extensive debate in the literature on whether 5-ARIs directly increase the risk of high-grade cancers through some biologic mechanism. Although this is still an open question, the majority of the data seems to suggest that use of 5-ARIs does not directly increase this risk. Owing to the inherent limitations in observational data, we do not feel that our study meaningfully contributes to this question.
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Sarkar RR, Rose BS. Benefits of Targeted Use of 5α-Reductase Inhibitors in Patients With Prostate Cancer—Reply. JAMA Intern Med. 2019;179(10):1442. doi:10.1001/jamainternmed.2019.3890
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