Impact of Androgen Suppression Therapy on the Risk and Prognosis of Bladder Cancer: A Systematic Review and Meta-Analysis

Abstract

PurposeThe purpose of this study was to summarize the existing evidence and develop a comprehensive systematic review of the impact of androgen suppression therapy (AST) on the incidence or clinical outcomes of bladder cancer.MethodsWe systematically searched the PubMed and Embase databases from inception to June 20, 2021 to identify all observational studies examining the incidence or clinical outcomes of bladder cancer in patients who received AST. AST is defined as the use of 5-alpha reductase inhibitors (5-ARIs) or androgen deprivation therapy (ADT).ResultsA total of 18 observational studies were included. Our results showed that AST was not significantly associated with a reduced risk of BCa incidence (OR: 0.92, 95% CI: 0.68–1.24) compared with the lack of AST. The subgroup analysis revealed that finasteride use was significantly associated with a reduction in the risk of BCa incidence (OR: 0.75, 95% CI: 0.64–0.88). Recurrence-free survival (RFS) was improved among AST users compared with nonusers (HR: 0.68, 95% CI: 0.48–0.95), while no significant difference between AST users versus nonusers was identified for cancer-specific survival (CSS), overall survival (OS) or progression-free survival (PFS).ConclusionCurrent evidence indicates that therapy with finasteride may represent a potential strategy aimed at reducing BCa incidence. Moreover, AST has a beneficial effect on the recurrence of bladder cancer. Further well-designed randomized trials or cohort studies with better characterized study populations are needed to validate our preliminary findings.Systematic Review RegistrationInternational Prospective Register of Systematic Reviews database [https://www.crd.york.ac.uk/PROSPERO/], identifier CRD42021261685.

Secondary bladder and colorectal cancer after treatments for prostate cancer: A population based study

“…When combined to EBRT, the association remains present, even if marginally non‐significant when adjusted in colorectal cancer. Regarding secondary bladder cancer, our results differ from previous literature suggesting that ADT can reduce primary bladder cancer incidence, recurrence and specific mortality 27,28 . A retrospective Japanese study found a secondary bladder cancer occurred in 14 (2.2%), 5 (1.1%), and 0 (0%) PCa patients treated with RT, RP, and ADT, respectively.…”

“…Regarding secondary bladder cancer, our results differ from previous literature suggesting that ADT can reduce primary bladder cancer incidence, recurrence and specific mortality. 27,28 A retrospective Japanese study found a secondary bladder cancer occurred in 14 (2.2%), 5 (1.1%), and 0 (0%) PCa patients treated with RT, RP, and ADT, respectively. Though a low incidence was observed for RT and ADT, it should be considered that the follow-up was short (50 months) 29 and usually, the lag period (time elapsed for a tumor to be considered induced by radiation), involves F I G U R E 1 Cumulative incidence functions for secondary bladder cancer and colorectal cancer.…”