Details

Autor(en) / Beteiligte

• Murtola, Teemu J
• Kujala, Paula M
• Tammela, Teuvo LJ

Titel

High-grade prostate cancer and biochemical recurrence after radical prostatectomy among men using 5[alpha]-reductase inhibitors and alpha-blockers

Ist Teil von

• The Prostate, 2013-06, Vol.73 (9), p.923

Ort / Verlag

Hoboken: Wiley Subscription Services, Inc

Erscheinungsjahr

2013

Link zum Volltext

Quelle

Wiley-Blackwell Journals

Beschreibungen/Notizen

• BACKGROUND Two clinical trials have shown that users of 5[alpha]-reductase inhibitors finasteride and dutasteride (5-ARIs) have reduced overall prostate cancer risk, while the proportion of high-grade tumors is increased. We studied tumor characteristics, risk of biochemical recurrence and mortality after radical prostatectomy in 5-ARI and alpha-blocker users. METHODS The study cohort consisted of 1,315 men who underwent radical prostatectomy at the Tampere University Hospital during 1995-2009. Biochemical relapse was defined as serum PSA≥0.2ng/ml after the operation. Information on mortality and medication purchases was obtained from national registries. Cox proportional regression was used to analyze hazard ratios (HRs) and 95% confidence intervals (95% CI) of biochemical relapse and death. RESULTS The proportion of high-grade (Gleason 7-10) tumors was significantly elevated among men who had used 5-ARIs for 4 years or longer compared to the non-users (83.3% vs. 53.3%, respectively). Survival curves for biochemical relapse-free survival differed between long-term and short-term 5-ARI users, but the hazard ratio remained statistically non-significant. Risk of biochemical recurrence was elevated among alpha-blocker users (HR 1.68, 95% CI 1.37-2.06), but in sensitivity analyses this was evident only in men using alpha-blockers after prostatectomy. Mortality was not associated with medication usage. CONCLUSIONS Long-term users of finasteride or dutasteride had more often high-grade prostate cancer. Our results suggest also worse progression-free survival. The association between risk of biochemical recurrence and post-operative alpha-blocker usage suggests that voiding or storage symptoms after prostatectomy may predict biochemical relapse. Prostate 73: 923-931, 2013. © 2013 Wiley Periodicals, Inc.