Inhibidores de la 5a-reductasa en la prevención del cáncer de próstata

Ariel Anthony Mejía-Pazmiño; Ángel Geovanny Romo-López

Autores/as

Ariel Anthony Mejía-Pazmiño Universidad Técnica de Ambato. Ecuador. https://orcid.org/0009-0004-7811-3563
Ángel Geovanny Romo-López Universidad Técnica de Ambato. Ecuador. https://orcid.org/0000-0003-4733-2355

Palabras clave:

Cáncer de próstata, inhibidores 5-alfa reductasa, quimioprevención, farmacogenética

Resumen

El cáncer de próstata es una de las principales causas de mortalidad masculina global. La enzima 5-alfa reductasa, a través de la dihidrotestosterona, juega un papel central en la progresión tumoral prostática, esto ha impulsado el uso de inhibidores de la 5-alfa reductasa (5-ARI) como estrategia de quimioprevención. Este artículo tiene como objetivo analizar, desde una perspectiva cualitativa, los mecanismos moleculares, eficacia clínica y perfil de seguridad de los inhibidores de la 5α-reductasa (5-ARI) en la prevención primaria. Se realizó una revisión exhaustiva de la literatura reciente entre el 2020 al 2025, priorizando estudios originales y revisiones sistemáticas. Los resultados describen que los 5-ARI modulan la actividad androgénica prostática, favoreciendo la apoptosis y reduciendo la proliferación celular, con impacto comprobado en la reducción de la incidencia y progresión de tumores de bajo e intermedio grado, sin incrementar la mortalidad ni los eventos adversos graves. La farmacogenética y factores individuales condicionan la respuesta terapéutica que apoya la eficacia y seguridad de los 5-ARI, subrayando la importancia de la selección individualizada basada en factores clínicos y genéticos, y en el monitoreo adecuado del PSA. Los 5-ARI constituyen una alternativa efectiva y segura para la prevención primaria del cáncer de próstata, recomendándose estrategias de medicina personalizada y vigilancia clínica constante.

Citas

Ayeni, T. O., Bajepade, T. I., Akanni, M. H., Pirisola, A. J., Oluwajembola, A. M., & Chinedu, S. N. (2024). The association of steroid 5-alpha reductase type-II gene polymorphisms (A49T and V89L) with prostate cancer risk in African population: A systematic review and meta-analysis. Scientific African, 26, e02370.

Baboudjian, M., Gondran-Tellier, B., Dariane, C., Fiard, G., Fromont, G., Rouprêt, M., & Ploussard, G. (2023). Association Between 5α-Reductase Inhibitors and Prostate Cancer Mortality: A Systematic Review and Meta-analysis. JAMA oncology, 9(6), 847–850. https://doi.org/10.1001/jamaoncol.2023.0260

Björnebo, L., Nordström, T., Discacciati, A., Palsdottir, T., Aly, M., Grönberg, H., Eklund, M., & Lantz, A. (2022). Association of 5α-reductase inhibitors with prostate cancer mortality. JAMA Oncology, 8(7), 1019–1026. https://doi.org/10.1001/jamaoncol.2022.1501

Chang, L. W., Wang, S. S., Yang, C. K., Lu, K., Chen, C. S., Cheng, C. L., Hung, S. C., Chiu, K. Y., Hsu, C. Y., & Li, J. R. (2023). Risk Analysis of Prostate Cancer Development Following Five-alpha Reductase Inhibitor Treatment for Benign Prostate Hyperplasia. Anticancer research, 43(1), 485–491. https://doi.org/10.21873/anticanres.16185

Chislett, B., Chen, D., Perera, M. L., Chung, E., Bolton, D., & Qu, L. G. (2023). 5-alpha reductase inhibitors use in prostatic disease and beyond. Translational Andrology and Urology, 12(3), 487–496. https://doi.org/10.21037/tau-22-690

Hamilton, R. J., Chavarriaga, J., Khurram, N., Lau, C., Luo, J., Liu, N., Komisarenko, M., Kulkarni, G., Wallis, C., Juurlink, D. N., Fleshner, N., & Finelli, A. (2024). 5-α reductase inhibitors and prostate cancer mortality. JAMA Network Open, 7(8), e2430223. https://doi.org/10.1001/jamanetworkopen.2024.30223

Kim, J., Jang, S. Y., & Park, E. C. (2025). Differential association between cumulative dose of 5α-reductase inhibitors and mortality. Scientific reports, 15(1), 10962. https://doi.org/10.1038/s41598-025-95583-w

Knijnik, P. G., Brum, P. W., Cachoeira, E. T., Paludo, A. O., Gorgen, A. R. H., Burttet, L. M., Neyeloff, J. L., & Neto, B. S. (2021). The impact of 5-alpha-reductase inhibitors on mortality in a prostate cancer chemoprevention setting: a meta-analysis. World journal of urology, 39(2), 365–376. https://doi.org/10.1007/s00345-020-03202-2

Lacy, J. M., & Kyprianou, N. (2014). A tale of two trials: The impact of 5α-reductase inhibition on prostate cancer (Review). Oncology letters, 8(4), 1391–1396. https://doi.org/10.3892/ol.2014.2388

Loughlin K. R. (2021). The clinical applications of five-alpha reductase inhibitors. The Canadian journal of urology, 28(2), 10584–10588. https://pubmed.ncbi.nlm.nih.gov/33872554/

Meenrajan, S. R. (2024). Using 5 alpha reductase inhibitors safely: What primary care physicians need to know. Journal of family medicine and primary care, 13(11), 4797–4799. https://doi.org/10.4103/jfmpc.jfmpc_575_24

Palacios, J. M., Kapse, P., Cortes, V., Averbeck, M. A., Alba, A. B., Somvanshi, S., da Costa Cruz, D. S. L., & Pereira, F. (2025). Monitoring of prostate-specific antigen in men with benign prostate enlargement receiving 5-alpha reductase inhibitors: a non-interventional, cross-sectional study of real-world practice of urologists in Spain and Brazil. BMC urology, 25(1), 22. https://doi.org/10.1186/s12894-025-01701-1

Sakalis, V., Gkotsi, A., Charpidou, D., Tsafrakidis, P., & Apostolidis, A. (2021). The effect of pharmacotherapy on prostate volume, prostate perfusion and prostate-specific antigen (prostate morphometric parameters) in patients with lower urinary tract symptoms and benign prostatic obstruction. A systematic review and meta-analysis. Central European journal of urology, 74(3), 388–421. https://doi.org/10.5173/ceju.2021.132.R1

Salisbury, B. H. (2024). 5α-Reductase Inhibitors. StatPearls. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK555930/

Song, Y., & Xu, T. (2023). Letter to the editor for the article “5-alpha reductase inhibitors (5-ARi) with or without alpha-blockers (α-B) for benign prostatic hyperplasia do not lower the risk of incident bladder cancer: United States insurance claims data”. World Journal of Urology, 41, 3379–3380. https://doi.org/10.1007/s00345-023-04607-5

Thakrar, D. B., Douglas, I. J., Smeeth, L., & Bhaskaran, K. (2023). Five-alpha reductase inhibitors and risk of prostate cancer among men with benign prostatic hyperplasia: A historical cohort study using primary care data. Wellcome open research, 8, 295. https://doi.org/10.12688/wellcomeopenres.19566.1

Vaselkiv, J. B., Ceraolo, C., Wilson, K. M., Pernar, C. H., Rencsok, E. M., Stopsack, K. H., Grob, S. T., Plym, A., Giovannucci, E. L., Olumi, A. F., Kibel, A. S., Preston, M. A., & Mucci, L. A. (2022). 5-Alpha Reductase Inhibitors and Prostate Cancer Mortality among Men with Regular Access to Screening and Health Care. Cancer epidemiology, biomarkers & prevention: a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 31(7), 1460–1465. https://doi.org/10.1158/1055-9965.EPI-21-1234

Wu, Y., Wang, Y., Gu, Y., Xia, J., Qian, Q., & Hong, Y. (2020). Prostate cancer risk and prognostic influence among users of 5-alpha-reductase inhibitors and alpha-blockers: A systematic review and meta-analysis. Urology, 145, 216–223. https://doi.org/10.1016/j.urology.2020.05.105

Yang, D. Y., Seo, W. W., Park, R. W., Rhee, S. Y., Cha, J. M., Hah, Y. S., Jeong, C. W., Kim, K. J., Yang, H. J., Kim, D. K., & Ha, J. Y. (2025). Comparison of Finasteride and Dutasteride on Risk of Prostate Cancer in Patients with Benign Prostatic Hyperplasia: A Pooled Analysis of 15 Real-world Databases. The world journal of men's health, 43(1), 188–196. https://doi.org/10.5534/wjmh.230327