Clinical significance of 5 alpha reductase inhibitor and androgen deprivation therapy on bladder cancer incidence, recurrence and survival: Meta-analysis and Systemic review
Prof. Hyun Woo Kim (1), Prof. Hyeong Gon Kim (1)
(1) Department of Urology, Catholic University hospital, Seoul, Korea, (2) Department of Urology, Catholic University hospital, Seoul, Korea
The aim of this study was to investigate the impact of androgen suppression therapy (AST), which comprise of 5- α reductase inhibitor (5-ARi) and androgen deprivation therapy (ADT), on the risk of incidence, recurrence and survival in men with bladder cancer.
We used the PRISMA statement to report the methods and results of the present review. We evaluated effect of androgen suppression therapy on outcome of bladder cancer. Incidence, cancer specific death, and recurrence of bladder cancer after the intervention were assessed using risk ratios (RRs) and hazard ratios (HRs) with 95% confidence intervals (CIs). The protocol for the present meta-analysis was registered in the PROSPERO database (No. CRD42018118627).
We analyzed nine studies (n=377,427) assessed on secondary effect of AST with mean follow-up of 6 years (range from 2 to 13 years). Our result showed that AST significantly reduced the incidence of bladder cancer when medication started before diagnosis of bladder cancer (RR, 0.69; 95% CI, 0.58–0.81; I2=0% and HR, 0.81; 95% CI, 0.70–0.94; I2=33%, respectively). When the interventions applied after diagnosis of bladder cancer, 5-ARi reduced cancer-specific mortality (RR, 0.29; 95% CI, 0.20–0.42; I2=4.1%) while ADT reduced bladder cancer recurrence (HR, 0.30; 95% CI, 0.19–0.49; I2=0%).
The present study supports that usage of 5-ARi and ADT can be helpful in managing bladder cancer and should not be limited to prostatic abnormality.