Benign prostatic hyperplasia and subsequent risk of bladder cancer

Abstract

We evaluated the risk of bladder cancer in a cohort of 79 280 Swedish men hospitalised for benign prostatic hyperplasia (BPH), identified in the Swedish Inpatient Register between 1964 and 1983 and followed until 1989 via multiple record linkages with nationwide data on cancer registry, death and emigration. Standardised incidence ratios (SIRs), the ratios of the observed to the expected numbers of incident bladder cancers, were used to calculate the risk associated with BPH. The expected number was calculated by multiplying the number of person-years by the age-specific cancer incidence rates in Sweden for each 5-year age group and calendar year of observation. Analyses were stratified by BPH treatment, latency, calendar year and presence of genitourinary (GU) comorbid conditions. After excluding the first 3 years of follow-up after the index hospitalisation, we observed 506 incident bladder cancer cases during follow-up in the cohort. No overall increased risk of bladder cancer was apparent in our main analysis involving the entire BPH cohort. However, among BPH patients with transurethral resection of the prostate (TURP), there was an increased risk in all follow-up periods; SIRs of bladder cancer during years 4 -6 of follow-up was 1.22 (95% confidence interval ¼ 1.02 -1.46), 1.32 for 7 -9 years of follow-up, and 1.47 for 10 -26 years of follow-up. SIRs of bladder cancer among TURPtreated BPH patients were particularly elevated among those with comorbid conditions of the GU tract (e.g., stone, infection, etc.); 1.72, 1.74 and 2.01 for 4 -6, 7 -9, 10 -26 years of follow-up, respectively, and also for those whose diagnoses occurred before 1975, when TURP was more likely to be performed by a urologist than a general practitioner: 1.87, 1.90 and 1.74, respectively. These findings suggest that BPH overall is not associated with bladder cancer risk. However, among men treated with TURP, particularly those with other comorbid GU tract conditions, risk of bladder cancer was elevated.

Benign prostatic hyperplasia is a significant risk factor for bladder cancer in diabetic patients: a population-based cohort study using the National Health Insurance in Taiwan

“…In the Swedish prospective follow-up study, there was a lack of an overall risk of bladder cancer associated with BPH [7], in contrary to a significant association in the present study (Tables 2 and 4). There were several possible explanations.…”

“…Furthermore, different ethnicities might also be a possible explanation. It should be pointed out that the Swedish study did show a significantly 2-fold higher risk of bladder cancer in a subgroup of the BPH men who underwent transurethral resection of the prostate and had genitourinary conditions such as urinary tract infection and stones [7]. This was consistent with the findings of the present study (Tables 2 and 4), and with our previous study showing a significantly higher risk of bladder cancer in patients with a history of urinary tract infection or stones [21].…”

“…Two early case–control studies suggested an increased risk [5,6]. A recent cohort study recruiting 79280 Swedish men hospitalized for BPH from 1964 to 1983 and following the patients until 1989 concluded that the overall risk of bladder cancer was not increased with BPH, but patients who underwent transurethral resection of the prostate had a significantly 47% higher risk [7]. …”

Impact of post‐void residual urine volume on intravesical recurrence after nephroureterectomy for upper urinary tract urothelial carcinoma

“…14 Patients treated with TUR-P have an elevated risk of bladder cancer. 3 One possible reason for this increased risk is that TUR-P might not completely excise the enlarged prostate, and incomplete BPH treatment might increase the risk of BPH-related adverse effects, such as urinary retention, post-void residual urine and other urinary symptoms. These adverse effects could in turn increase the risk of bladder cancer.…”

“…An observational study of 79 280 Swedish men with BPH showed that although BPH overall was not associated with a risk of bladder cancer, TUR-P was associated with an elevated risk of bladder cancer. 3 In a rat model, exposure of the bladder to carcinogens after induction of bladder hyperplasia and hypertrophy by partial bladder outlet obstruction resulted in a greater incidence of superficial bladder carcinoma. 4 Thus, LUTS might have an association with bladder cancer.…”