The effect of dutasteride on the detection of prostate cancer: A set of meta-analyses
DOI:
https://doi.org/10.5489/cuaj.477Keywords:
benign prostatic hyperplasia, BPH, 5ARI, combination therapy, CombAT, dutasteride, Gleason scores, high-grade tumours, prostate cancer, REDUCE, tamsulosinAbstract
Background: Dutasteride has been shown to significantly improve symptoms of benign prostatic hyperplasia (BPH) and reduce clinical progression. Recent data from studies evaluating 5-alpha reductase inhibitors (5-ARIs) for the prevention of prostate cancer, however, suggest 5ARIs, including dutasteride, may be associated with increased incidence of Gleason 8-10 prostate tumours. This meta analysis was undertaken to quantify the effect of dutasteride on detection of prostate cancer and high-grade prostate cancer.
Methods: Our meta-analysis includes data from GlaxoSmithKline sponsored phase III randomized clinical trials (with a study duration of ≥2 years) evaluating the effect of dutasteride, alone or incombination with tamsulosin, to treat BPH or to reduce the risk of prostate cancer. The incidence of prostate cancer, including Gleason 7-10 and Gleason 8-10, for patients taking either dutasteride, dutasteride plus tamsulosin, tamsulosin alone, or placebo, were evaluated using the Mantel-Haenszel Risk Ratio (MHRR) method of conducting meta-analyses.
Results: The meta-analysis demonstrated that in a population with symptomatic BPH and/or at increased risk of prostate cancer, a statistically significant lower number of detectable prostate cancers was found in men taking dutasteride compared to control groups (MHRR: 0.66, 95% CI 0.52-0.85). In our analysis, there was no increased risk for Gleason 7-10 (MHRR: 0.83, 95% CI 0.56-1.21) or Gleason 8-10 prostate cancers (MHRR: 0.99, 95% CI 0.39-2.53) in men taking dutasteride over control groups. There were several limitations that need to be considered when interpreting these results.
Conclusion: These data provide support for the continued use of dutasteride in the treatment of symptomatic BPH patients.
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