Receipt of 5-Alpha Reductase Inhibitors Before Radical Cystectomy: Do They Render High-Grade Bladder Tumors Less Aggressive?

    August 2019 in “ Clinical genitourinary cancer ”
    Catherine McMartin, Louis Lacombe, Yves Fradet, Yves Fradet, Michele Lodde, Paul Toren
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    TLDR Taking 5-Alpha Reductase Inhibitors before bladder removal surgery might make high-grade bladder tumors less aggressive.
    The study, conducted between 2009 and 2017, included 338 men who underwent radical cystectomy (RC) for urothelial cancer and aimed to determine if preoperative 5-alpha reductase inhibitors (5-ARIs) affected surgical pathology and clinical outcomes. It was found that among the 48 patients (14%) receiving 5-ARIs, there was a statistically significant lower proportion of positive margins and lymphovascular invasion, particularly when excluding patients with urothelial carcinoma variants. Multivariable logistic regression analysis showed that 5-ARI receipt was associated with a lower odds ratio for lymphovascular invasion (OR = 0.49; P = .049) and positive surgical margins (OR = 0.30; P = .063), as well as better overall survival (adjusted hazard ratio of 0.40; P = .015). No similar effects were observed with metformin or statins. The conclusion suggests that 5-ARIs may reduce the invasive properties of high-grade urothelial carcinoma, warranting further research for therapeutic implications.
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      Androgen suppression therapy (AST) doesn't significantly lower bladder cancer risk, but using finasteride, a type of AST, might decrease the risk. AST also lessens the chance of cancer coming back but doesn't really affect survival rates. More research is needed to understand AST's benefits for different bladder cancers.
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      research Table 1

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      Androgen suppression therapy (AST) doesn't significantly lower bladder cancer risk, but using finasteride, a type of AST, might reduce it. AST decreases recurrence-free survival but doesn't affect overall survival or progression-free survival. More research is needed to understand AST's benefits.