The Use of 5-Alpha Reductase Inhibitors and Alpha-1 Blockers Does Not Improve Clinical Outcome in Male Patients Undergoing Radical Cystectomy for Bladder Cancer in Quebec, Canada.

Previous studies have suggested that medications used for patients with enlarged prostates, may improve the clinical outcome for bladder cancer patients. Using provincial databases in Quebec, Canada, we identified a group of 2822 men who had their bladder removed due to bladder cancer between 20 0 0 and 2015. Contradicting the published literature, patients in our large cohort who used these prostate medications had a similar to worse survival than patients who did not use these medications. Background: Existing literature suggests that bladder cancer (BC) outcome may be improved when patients use 5 a-reductase inhibitors and/or α1 -blockers, but such a conclusion may be subject to publication bias. We evaluated whether preoperative use of 5 α-reductase inhibitors or α1 -blockers was associated with improved clinical outcomes in a cohort of patients with BC undergoing radical cystectomy (RC). Patients and Methods: Using provincial health administrative databases, we retrospectively identified male BC patients undergoing RC in Quebec province between 2000 and 2015, and we collected data from 2 years before RC until December 2016 or death. Survival analyses were conducted using Kaplan-Meier curves, log-rank tests, propensity score matching, and uni- and multivariable Cox proportional hazards models. Covariates included age, Charlson's comorbidity index, region of residence, year of RC, distance to hospital, hospital type, annual RC volume of each hospital and surgeon, neoadjuvant chemotherapy use, and type of bladder diversion. Results: Of the 2822 patients included, 284 patients used 5 α-reductase inhibitors and 1001 patients used α1 -blockers prior to surgery. Median follow-up time was 7.7 years. Patients who used 5 α-reductase inhibitors or α1 -blockers were generally older, had more comorbidities, and were treated more recently in academic centers. Overall, bladder cancer-specific and recurrence-free survival did not differ significantly between those using 5 α-reductase inhibitors prior to surgery and controls who never used 5 α-reductase inhibitors. Adjusted hazard ratios were 1.03 (95% confidence interval [CI], 0.88-1.21) for overall survival, 1.12 (95% CI, 0.92-1.36) for bladder cancer-specific survival, and 1.19 (95% CI, 0.99-1.42) for recurrence-free survival. The aforementioned outcomes were significantly worse in patients who used α1-blockers prior to surgery compared to controls, with respective adjusted hazard ratios of 1.15 (95% CI, 1.04-1.27), 1.19 (95% CI, 1.05-1.35), and 1.18 (95% CI, 1.05-1.33). Conclusion: Preoperative use of 5 α-reductase inhibitors and α1 -blockers did not improve clinical outcome in our cohort of male patients undergoing radical cystectomy for bladder cancer. [ABSTRACT FROM AUTHOR]