The effect of 5α-reductase inhibitors on prostate growth in men receiving testosterone replacement therapy: a systematic review and meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 23728850 · doi:10.1007/s11255-013-0477-0
What was done
A systematic review and meta-analysis of MEDLINE, EMBASE, and the Cochrane Controlled Trials Register was performed to evaluate the effect of adding 5α-reductase inhibitors (5ARIs) to testosterone replacement therapy for hypogonadism. Authors included randomized placebo-controlled trials comparing testosterone plus a 5ARI against testosterone plus placebo, evaluating prostate-specific antigen (PSA) and prostate volume at short-term (≤6 months) and long-term (18–36 months) durations.
What was found
Five publications comprising 250 patients were included (4 short-term and 3 long-term comparisons): - Short-term (≤6 mo): 5ARI co-treatment significantly reduced PSA levels compared to testosterone plus placebo (SMD = -0.24, 95% CI -0.45 to 0.04, p = 0.02), with no statistically significant effect on prostate volume (SMD = -1.66, 95% CI -4.54 to 1.22, p = 0.26). - Long-term (18–36 mo): 5ARI co-treatment significantly decreased PSA (SMD = -0.53, 95% CI -0.84 to 0.21, p = 0.001) and slowed prostate growth progression (SMD = -8.53, 95% CI -15.51 to 1.54, p = 0.02).
Why it matters
Concern over prostate enlargement often limits testosterone prescribing in late-onset hypogonadism. This review suggests that co-administering a 5ARI can counteract prostate growth and reduce PSA increases associated with testosterone therapy.
Limits
The total sample size is very small (250 patients across 5 studies). The abstract contains apparent reporting anomalies in the reported 95% confidence intervals crossing zero despite significant p-values. Functional urinary outcomes, symptom scores, and adverse event rates were not reported in the abstract.
Cited by
- supports Testosterone replacement therapy can potentially increase prostate size and exacerbate benign prostatic hyperplasia (BPH).