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Impact of 5α‐reductase inhibitor and α‐blocker therapy for benign prostatic hyperplasia on prostate cancer incidence and mortality
Author(s) -
Van Rompay Maria I.,
Curtis Nickel J.,
Ranganathan Gayatri,
Kantoff Philip W.,
Solomon Keith R.,
Lund Jennifer L.,
McKinlay John B.
Publication year - 2019
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.14534
Subject(s) - medicine , hazard ratio , prostate cancer , incidence (geometry) , proportional hazards model , cohort , retrospective cohort study , confidence interval , urology , gynecology , cancer , hyperplasia , physics , optics
Objective To investigate the use of 5α‐reductase inhibitors (5 ARI s) and α‐blockers among men with benign prostatic hyperplasia ( BPH ) in relation to prostate cancer ( PC a) incidence, severity and mortality. Patients and Methods A retrospective 20‐year cohort study in men residing in Saskatchewan, aged 40–89 years, with a BPH ‐coded medical claim between 1995 and 2014, was conducted. Cox proportional hazards regression was used to compare incidence of PC a diagnosis, metastatic PC a, Gleason score 8–10 PC a, and PC a mortality among 5 ARI users ( n = 4 571), α‐blocker users ( n = 7 764) and non‐users ( n = 11 677). Results In comparison with both non‐users and α‐blocker users, 5 ARI users had a ~40% lower risk of a PC a diagnosis (11.0% and 11.4% vs 5.8%, respectively), and α‐blocker users had an 11% lower risk of a PC a diagnosis compared with non‐users. Overall, the incidence of metastatic PC a and PC a mortality was not significantly different among 5 ARI or α‐blocker users compared with non‐users (adjusted hazard ratios [HR] of metastatic PCa: 1.12 and 1.13, respectively, and PCa mortality: 1.11 and 1.18, respectively, P > 0.05 for both drugs), but both 5ARI and a‐blocker users had ~30% higher risk of Gleason score 8–10 cancer, adjusted HR 1.37, 95% confidence interval [ CI ] 1.03–1.82, P = 0.03, and adjusted HR 1.28, 95% CI 1.03–1.59, P = 0.02, respectively compared with non‐users. Conclusion The use of 5 ARI s was associated with lower risk of PC a diagnosis, regardless of comparison group. Risk of high grade PC a was higher among both 5 ARI users and α‐blocker users compared with non‐users; however, this did not translate into higher risk of PC a mortality.