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Zhu D , Srivastava A , Agalliu I , Fram E , Kovac EZ , Aboumohamed A , Schoenberg MP , Sankin AI
Finasteride Use and Risk of Bladder Cancer in a Multiethnic Population
J Urol. 2021 Jul;206(1) :15-21
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Abstract
PURPOSE: Finasteride use has been associated with a reduced incidence of bladder cancer (BCa). However, the majority of studies have been conducted primarily in East Asian or Caucasian populations. Given differences in the incidence of BCa among racial/ethnic groups, it is important to determine whether the effect of finasteride use on BCa varies by race/ethnicity. MATERIALS AND METHODS: We identified all patients with a diagnosis of benign prostatic hypertrophy (BPH) between 2000 and 2016 at our academic health center in Bronx, NY, via an electronic medical record database. We then identified patients who were prescribed finasteride, and those that developed BCa during follow-up. We used competing risk analysis to examine associations of finasteride use with risk of BCa, adjusting for age, smoking and race/ethnicity. RESULTS: We identified 42,406 patients with BPH (average age 67±12.9 years), of whom 27.7% were African American and 14.8% were Hispanic. Finasteride was prescribed in 5,698 (13.4%) patients. BCa was diagnosed in 84 of 5,698 (1.5%) finasteride-users, compared to 762 of 36,708 (2.1%) non-users (log-rank p=0.003). Finasteride was associated with a 36% reduction in risk of BCa (HR: 0.64, 95% CI: 0.51-0.80, p <0.0001) among all patients. When data were stratified by race/ethnicity, finasteride use was associated with a reduction in risk of BCa in Caucasians (HR: 0.61, 95% CI: 0.43-0.86, p=0.005) and Hispanic men (HR: 0.44, 95% CI: 0.21-0.90, p=0.026), but there was no association among African American men (HR: 1.01, 95%CI: 0.67-1.51, p=0.964). CONCLUSIONS: Our study corroborates previous findings that men who are on finasteride have a lower BCa incidence. However, the reduction in risk was seen only in Caucasians and Hispanics, but not among African Americans. Therefore, race/ethnicity represents an important stratification factor for future larger studies on finasteride as chemoprevention for BCa.
Notes
1527-3792 Zhu, Denzel Srivastava, Abhishek Agalliu, Ilir Fram, Ethan Kovac, Evan Z Aboumohamed, Ahmed Schoenberg, Mark P Sankin, Alexander I Journal Article United States J Urol. 2021 Feb 22:101097JU0000000000001694. doi: 10.1097/JU.0000000000001694.