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

• Type of Material: Article
• Authors: Francesco Del Giudice, University of Rome; Federico Belladelli, Stanford University; Frank Glover III, Emory University; Satvir Basran, Stanford University; Shufeng Li, Stanford University; Evan Mulloy, Stanford University; Benjamin Pradere, Medical University of Vienna; Francesco Soria, University of Studies of Torino; Wojciech Krajewski, Wrocław Medical University; Rajesh Nair, Guys and St. Thomas’ NHS Foundation Trust; Wade Muncey, Stanford University; Nicolas Seranio, Stanford University; Michael L. Eisenberg, Stanford University
• Language: English
• Date: 2023-08-07
• Publisher: Springer Nature
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): https://doi.org/10.1007/s00345-023-04551-4
• Title of Journal or Parent Work: World Journal of Urology
• Volume: 41
• Issue: 10
• Start Page: 2783
• End Page: 2791
• Grant/Funding Information: Open access funding provided by Università degli Studi di Roma La Sapienza within the CRUI-CARE Agreement.
• Keywords: 5-alpha reductase inhibitor (5-ARi); urology; Benign prostatic hyperplasia; Bladder cancer; Alpha blockers
• Research Categories: Health Sciences, Pharmacology; Health Sciences, Oncology; Health Sciences, Epidemiology

Abstract

Background Chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer (BCa) risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results. We sought to examine the effect of 5-ARi on new BCa diagnoses in a large US database. Methods Men ≥ 50 y/o with a prescription for 5-ARi after BPH diagnosis were identified in the IBM® Marketscan® Research de-identified Databases between 2007 and 2016 and matched with paired controls. Incident BCa diagnoses were identified after BPH diagnosis and/or pharmacologic treatment. Multivariable regression modeling adjusting for relevant factors was implemented. Sub-group analyses by exposure risk were performed to explore the association between 5-ARi and BCa over time. Administration of alpha-blockers (α-B) w/o 5-ARi was also examined. Results In total, n = 24,036 men on 5-ARi, n = 107,086 on 5-ARi plus alpha-blockers, and n = 894,275 without medical therapy for BPH were identified. The percentage of men diagnosed with BCa was 0.8% for the 5-ARi, 1.4% for the 5-ARi + α-B, and 0.6% for the untreated BPH group of incident BCa (adjusted hazard ratio [aHR], 0.90, 95% confidence interval [CI] 0.56 – 1.47), and 1.08, 95%CI 0.89 – 1.30, respectively). This was also true at both shorter (≤ 2 yr) and longer-term (> 2 yr) follow up. In addition, α-B alone had no change in BCa risk (HR 1.06, 0.86–1.30). Conclusions We did not find any diminished risk of new BCa in men treated with 5-ARi (i.e., chemoprotective effect). The current report suggests that 5-ARi do not change a man’s bladder cancer risk.