Details

Autor(en) / Beteiligte

• Del Giudice, Francesco
• Nowak, Łukasz
• Glover, Frank
• Ha, Albert
• Scott, Michael
• Belladelli, Federico
• Basran, Satvir
• Li, Shufeng
• Mulloy, Evan
• Pradere, Benjamin
• Asero, Vincenzo
• Łaszkiewicz, Jan
• Krajewski, Wojciech
• Nair, Rajesh
• Eisenberg, Michael L

Titel

5α-reductase inhibitors with or without alpha-blockers and risk of incident upper tract urothelial carcinoma in men with benign prostatic hyperplasia: Analysis of US insurance claims data

Ist Teil von

• Urologic oncology, 2024-09

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2024

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• •The effect of 5-alpha reductase inhibitors on upper tract urothelial carcinoma has not been explored.•Men taking 5-alpha reductase inhibitors were identified using MerativeTM Marketscan®.•Total of 4,761 patients were diagnosed with upper tract urothelial carcinoma.•5-alpha reductase inhibitors did not protect from upper tract urothelial carcinoma.•Alpha-blockers did not have protective effect on upper tract urothelial carcinoma. Increasing data suggests that androgen receptor signaling may play an important role in the carcinogenesis of urothelial cancers. While the chemoprotective effect of 5-alpha reductase inhibitors (5-ARi) on bladder cancer risk in men with Benign Prostatic Hyperplasia (BPH) has been explored with conflicting results, the evidence regarding 5-ARi treatment, and the risk of incident Upper Tract Urothelial Carcinoma (UTUC) development is lacking. Therefore, our objective was to investigate the impact of the 5-ARi administration on the incidence of new UTUC cases using a large US database. The MerativeTM Marketscan® database was used to identify men ≥ 50 years old with a diagnosis of BPH and an active 5-ARi prescription between 2007 and 2021 and were subsequently matched with paired controls. A multivariable Cox regression model was implemented to ascertain the association of 5-ARi and/or alpha-blocker (α-B) medications on the incidence of UTUC. Additional subgroup analyses were conducted based on exposure risk (with a 2-year threshold) to investigate the relationship between 5-ARi and UTUC over time. Overall, n=1,103,743 men BPH without prescriptions for BPH, n=31,142 men on 5-ARi, and n=160,049 using 5-ARi + α-B were identified. Over the follow-up period, a total of n=4,761 patients were diagnosed with UTUC. After matching, UTUC incidence ranged from 0.36% to 0.41% in men without active BPH therapy vs. 0.30% and 0.52% for the 5-ARi and 5-ARi + α-B groups, respectively. In multivariable analysis, the chemoprotective effect on UTUC risk was not observed for either 5-ARi monotherapy (adjusted hazard ratio [aHR]: 0.91, 95% CI: 0.58–1.44) or 5-ARi + α-B combination (aHR: 1.02, 95% CI: 0.87–1.19). This remained true for both short-term (≤ 2 years) and long-term (> 2 years) follow-up periods. The use of 5-ARi for BPH, whether used alone or in combination with α-B, is not associated with incident UTUC.