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Impact of Finasteride on Survival in Bladder Cancer: A Retrospective Multi-institutional Database Analysis

Published:October 28, 2022DOI:https://doi.org/10.1016/j.clgc.2022.10.014

      Highlights

      • Androgen signaling pathway has been proposed to promote bladder tumorigenesis.
      • Men with bladder cancer, who were prescribed finasteride, were more likely to be older, diabetic, obese, and taking an alpha-blocker.
      • Use of finasteride after the diagnosis of bladder cancer is associated with superior overall survival in bladder cancer cohort as well as in high-risk non-muscle invasive bladder cancer.
      • Finasteride use appeared as an independent predictor for overall survival in bladder cancer as well as in high-risk non-muscle invasive bladder cancer.

      Abstract

      Introduction

      Androgen suppression therapy has been associated with a lower incidence of bladder cancer (BCa) or improved overall/cancer-specific survival. Results are ofent conflicting; therefore, we aim to assess the impact of use of finasteride on overall survival (OS) for BCa using multi-institutional database.

      Methods

      The South Texas Veterans Healthcare System from 5 medical centers was queried for patients with BCa with or without use of finasteride after diagnosis of BCa. The primary outcome was the impact of finasteride use after diagnosis on the OS in BCa and in the high-risk Non-muscle invasive BCa (NMIBC) cohort.

      Results

      A total of 1890 patients were included, amongst which 619 (32.8%) men were classified as finasteride users and 1271 (67.2%) men as controls. At a median (IQR) follow up of 53.8 (27.4, 90.9) months, death due to any cause was noted in 272 (43.9%) finasteride-treated, and 672 (49.3%) control groups (P = .028). The patients in the finasteride group had significantly better OS in overall cohort (112.1 months vs. 84.8 months, P < .001) as well as in the NMIBC cohort (129.3months vs. 103.2 months, P = .0046). The use of finasteride was independently associated with improved OS in both, overall cohort (HR 0.74, 95% CI 0.63-0.86; P < .001) and in the NMIBC cohort (HR = 0.71, 95% CI 0.55-0.93; P = .011).

      Conclusion

      Finasteride use is associated with the improved overall survival in patients with BCa, specifically in patients with NMIBC. We, further, propose a randomized clinical trial to investigate the use of finasteride in BCa patients.

      Keywords

      Abbreviations:

      BCa (Bladder Cancer), NMIBC (Non-Muscle Invasive Bladder Cancer), AR (Androgen Recepter), 5-ARI (5-apha reductase inhibitor), DHT (Dihydrotestosterone), BCG (Bacillus Calmette Guerin), TURBT (Transurethral Resection of Bladder Tumor), OS (Overall Survival), AST (Androgen Suppression Therapy)
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