Influence of 5‐Alpha Reductase Inhibitors on PI‐RADS Scores and Prostate Cancer Detection: A Systematic Review and Meta‐Analysis

Background The impact of 5‐alpha reductase inhibitors (5‐ARIs) on Prostate Imaging Reporting and Data System (PI‐RADS) tumor classifications and prostate cancer (PCa) detection were reviewed and analyzed. Method A comprehensive systematic review and meta‐analysis were conducted by evaluating published studies examining the influence of 5‐ARIs on PI‐RADS lesions and PCa detection. The Web of Science, PubMed, and Embase databases were accessed for relevant study retrieval. Statistical analyses were performed through the use of STATA v.16.0. Results Seven studies, comprising 12,132 participants, were included. Compared to men who had not received 5‐ARIs, those exposed to 5‐ARIs exhibited no significant differences in PCa diagnosis (OR 0.97, 95% CI 0.86–1.08; p = 0.55) or clinically significant PCa (csPCa) diagnosis (OR 1.01, 95% CI 0.89–1.16; p = 0.85). Further subgroup analyses demonstrated that 5‐ARI‐exposed men had comparable PCa diagnosis in PI‐RADS 3 (OR 0.85, 95% CI 0.65–1.12; p = 0.25), PI‐RADS 4 (OR 1.01, 95% CI 0.85–1.21; p = 0.84), and PI‐RADS 5 (OR 1.01, 95% CI 0.81–1.26; p = 0.87) groups relative to 5‐ARI‐naïve men. Conclusions These findings suggest that 5‐ARIs do not significantly alter PI‐RADS lesion distribution or impact PCa and csPCa diagnosis. Consequently, exposure to 5‐ARIs should not influence MRI‐based diagnostic approaches in patients with suspected PCa.