Receipt of 5-Alpha Reductase Inhibitors Before Radical Cystectomy: Do They Render 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.