(A-115) Impact of 5-Alpha Reductase Inhibitors (5-ARIs) in Prostate Cancer Risk Reduction in Patients with Negative Prostate Biopsy: A Systematic Review and Meta-Analysis.

Objectives:
To evaluate the efficacy and safety of 5-ARIs in reducing prostate cancer risk with a negative prostate biopsy, confirming the absence of cancerous cells in the sample.

Methods:
Studies searched in PubMed, Embase, Scopus, and the Google Scholar platform for randomized controlled trials (RCTs) of 5-ARIs (Finasteride & Dutasteride) in patients with negative biopsy. A meta-analysis was performed using the ‘meta’ package in R Studio (version 4.3.2) to analyse the data.

Results:
A total of 32 RCTs involving 59,608 patients compared 5-ARIs (Finasteride and Dutasteride) with a placebo. Results showed a reduction in DHT levels (Mean Difference (MD) -5.46 ng/dl; 95%CI; -10.8 to -0.11). PSA levels decreased (MD -2.46 ng/ml; 95% CI; -3.13 to -1.75) and PV reduced (MD -10.89cc; 95%CI; -13.42 to -8.37). Similarly, 5-ARIs improved Qmax (MD 0.92 ml/s; 95% CI; 0.45 to 1.39).
The incidence of Sexual Dysfunction was significantly higher in the 5-ARIs group (RR 1.81; 95%CI; 1.68 to 1.94). However, overall adverse event rates were higher in 5-ARIs (RR 0.99; 95% CI; 0.94 to 1.05) though this difference was not statistically significant.

Conclusion:
5-ARI therapy significantly improved Qmax and led to a statistically significant reduction in PSA, PV, and DHT levels in patients with a negative biopsy of prostate cancer. However, patients receiving 5-ARIs had a significantly higher risk of sexual dysfunction compared to placebo.