5-alpha reductase inhibitors decrease the level of dihydrotestosterone (DHT) by inhibiting 5-alpha reductase. Trials on 5-alpha reductase inhibitors in prostate cancer prevention showed that they could significantly decrease the incidence of prostate cancer, but meanwhile increase high-grade cases as well. Recent studies demonstrated that 5-alpha reductase inhibitors could reduce not only the prostate volume but also the volume of Gleason grade 3 prostate cancer, which made easier the detection of higher-grade prostate cancer in the second biopsy. 5-alpha reductase inhibitors could also increase the sensitivity of prostate biopsy in detecting prostate cancer, particularly that of a higher grade. The evidence we have obtained leads to the conclusion that 5-alpha reductase inhibitors do not increase the incidence of high-grade prostate cancer, but on the contrary help its earlier detection.