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Minerva Urologica e Nefrologica 2019 Dec 12

DOI: 10.23736/S0393-2249.19.03563-X


language: English

Possible role of 5-alpha reductase inhibitors in non-invasive bladder urothelial neoplasm: multicentre study

Antonio L. PASTORE 1, 2 , Andrea FUSCHI 1, 2, Cosimo DE NUNZIO 3, Matteo BALZARRO 4, Yazan AL SALHI 1, 2, Gennaro VELOTTI 1, 2, Alessia MARTOCCIA 1, 2, Lorenzo CAPONE 1, 2, Nelia AMIGONI 4, Mario FALSAPERLA 5, Consalvo MATTIA 6, Walter ARTIBANI 4, Andrea TUBARO 3, Antonio CARBONE 1, 2

1 Urology Unit, Department of Medico- Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy; 2 Uroresearch, no profit Association for Research in Urology, Latina, Italy; 3 Department of Urology, Sant’Andrea Hospital Rome, Sapienza University of Rome, Rome, Italy; 4 Department of Urology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Verona, Italy; 5 Department of Urology, Vittorio Emanuele Hospital, Catania Italy; 6 Anesthesiology Unit, Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy


BACKGROUND: About 75% of urothelial bladder cancers are non-muscle invasive (NMIBC), and limited to mucosa (Ta or CIS) or sub-mucosa (T1). An increase of androgen expression and androgen receptors has a positive effect on oncogenic expression. We aimed to evaluate whether 5-alpha reductase inhibitors (5-ARI) have a role in NMIBC.
METHODS: We retrospectively evaluated the clinical and pathological data of 423 patients with NMIBC who underwent transurethral bladder resection. We analysed the number of resections, number of total recurrences, time of recurrences, and histopathology details. The population was classified into two groups: treated and untreated with 5-ARIs. The enrolled patients were in treatment with 5ARIs for symptomatic prostatic hyperplasia for at least 12 months. Mean follow-up time was 30.43 months.
RESULTS: Patients treated with 5-ARIs had a lower rate of recurrence (14%) than the untreated group (37%). There was a significant difference in the mean number of recurrences between the untreated and the treated group (p value: 0.006). Furthermore, the treated group showed a significantly greater number of low than high grade tumours, compared to the untreated group (p value ≤ 0.05). There was a significant decrease in the number of muscle invasive tumours in treated patients (p value = 0.032). The recurrence- free survival rate of patients treated with 5-ARIs was significantly higher (p value: 0.0001).
CONCLUSIONS: Long-term treatment with 5- ARIs might reduce the risk of bladder tumour recurrence, extension of lesions and increase the recurrence-free survival rate. A long-term, randomized prospective study could definitively assess the possible role of these drugs.

KEY WORDS: Bladder cancer; 5 alpha reductase inhibitors; TURB; NMIBC

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