Use of 5α-reductase inhibitors (5-ARIs) prior to a bladder cancer diagnosis may reduce patients’ risks for disease progression, according to research published in JAMA Network Open.

Using the Korean National Health Insurance Service database, investigators identified 22,845 men diagnosed with bladder cancer who had pre-existing benign prostatic hyperplasia (BPH) treated with an α-blocker with or without a 5-ARI.

To reduce biases, the investigators propensity-score matched 5300 users of α-blockers alone to 5300 users of 5-ARIs plus α-blockers. BPH medications were required to be taken 12 or more months before bladder cancer diagnosis. The 5-ARIs include finasteride and dutasteride. The α-blockers include doxazocin, terazosin, tamsulosin, alfuzosin, silodosin, and naftopidil.

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The 5-ARI plus α-blocker group had a 16% lower risk of bladder instillation and a 26% lower risk of radical cystectomy than the α-blocker-only group, indicating delayed grade and stage progression with 5-ARI use. The 5-ARI group also had a 17% lower risk of all-cause mortality. All of these between-group differences were significant.

The between-group differences in restricted mean survival time were 88.1 days for bladder instillation, 68.0 days for radical cystectomy, and 92.6 days for all-cause mortality.

The investigators also found that, compared with the α-blocker-only group, the 5-ARI plus α-blocker group had numerically lower incidence rates (per 1000 person-years) of bladder instillation (66.43 vs 85.59) and radical cystectomy (13.56 vs 19.57).

The investigators found that only 5-ARI use of 2 years or more was significantly associated with reduced risk of radical cystectomy.

Results of previous studies have been conflicting, with some showing benefit with 5-ARI treatment and others showing no benefit.

“This cohort study found that the prediagnostic prescription of a 5-ARI was associated with a reduced risk of [bladder cancer] progression,” the investigators wrote. “However, the evidence was insufficient to inform the extension of 5-ARI indications. A prospective cohort study or RCT [randomized controlled trial] is needed to validate the findings of this study.”


An MH, Kim MS, Kim C, et al. Association of 5α-reductase inhibitor prescription with bladder cancer progression in males in South Korea. JAMA Netw Open. Published online May 16, 2023. doi:10.1001/jamanetworkopen.2023.13667

This article originally appeared on Renal and Urology News