5ARIs and PSA: Evidence

The review analyzed the impact of 5α-reductase inhibitors (5ARIs) on serum PSA levels and their role in prostate cancer screening. It was found that 5ARIs reduced serum PSA levels for up to 48 months, enhancing the diagnostic performance of PSA in detecting prostate cancer. However, this reduction also led to fewer diagnoses of indolent cancers. An increase in PSA from its lowest point was considered suspicious for malignancy, but relying solely on PSA levels for biopsy decisions could miss aggressive tumors. Therefore, other factors such as digital rectal examination, age, family history, and imaging should be considered in clinical follow-ups. Overall, 5ARIs improved PSA specificity but should not be the sole diagnostic tool for identifying prostate cancers with poor prognosis.