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High‐grade prostate cancer and biochemical recurrence after radical prostatectomy among men using 5α‐reductase inhibitors and alpha‐blockers
Author(s) -
Murtola Teemu J.,
Kujala Paula M.,
Tammela Teuvo L.J.
Publication year - 2013
Publication title -
the prostate
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.295
H-Index - 123
eISSN - 1097-0045
pISSN - 0270-4137
DOI - 10.1002/pros.22638
Subject(s) - dutasteride , medicine , prostatectomy , prostate cancer , hazard ratio , finasteride , biochemical recurrence , proportional hazards model , urology , 5 alpha reductase inhibitor , prostate , antiandrogen , cohort , gynecology , cancer , confidence interval , oncology
BACKGROUND Two clinical trials have shown that users of 5α‐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 ≥ 0.2 ng/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.