Does finasteride increase survival rates in males with bladder cancer?

Males with Bladder Cancer Have Improved Survival with Use of Oral Finasteride.

Bladder Cancer: How common is it?

Bladder cancer is the fourth most common cancer diagnosis in men in United States, with an estimated 81,180 new cases and 17,100 deaths expected in 2022. Prostate, lung and colorectral cancer are the most common cancers, but bladder cancer is number 4. According to Cancer.org, about 1 in 27 males will develop bladder cancer in their lifetime. The risk in females is lower with about 1 in 89 lifetime risk of bladder cancer. Androgen levels have, thus, been theorized to affect bladder cancer development and malignant transformation. Not surprisingly then, research has examined whether antiandrogens have the potential to impact bladder cancer.

Garg et al 2022

Authors of a new study compared the survival of males with bladder cancer who used finasteride with the survival of those who did not use finasteride. Patients were from the South Texas Veterans Healthcare System which included 5 medical centers.

The authors included men that began taking finasteride after the diagnosis of bladder cancer. Patients taking finasteride before or during the diagnosis of bladder cancer were excluded.

There were a total of 1890 patients included in the study. 619 (32.8%) males were finasteride users and 1271 (67.2%) males served as controls. At a median follow up of 53.8 months months, death due to any cause was noted in 272 (43.9%) finasteride-treated, and 672 (49.3%) control groups. This was statistically significant at p = .028).

The patients in the finasteride group had significantly better overall survival in overall cohort (112.1 months vs. 84.8 months, P < .001) as well as in the subtype of bladder cancer known as non muscle invasive bladder cohort (129.3 months vs. 103.2 months, P = .0046). (It should be noted that 90 % of more of bladder cancers begin in the cells on the surface of the bladder’s inner lining. This type of cancer is sometimes referred to as urothelial carcinoma. Most urothelial carcinomas are a form of non-muscle invasive bladder cancer (NMIBC). This simply refers to the fact that the cancer stays within the bladder’s inner lining)

The use of finasteride was independently associated with improved overall survival in both, overall cohort (HR 0.74, 95% CI 0.63-0.86; P < .001) and in the non muscle invasive bladder cancer cohort (HR = 0.71, 95% CI 0.55-0.93; P = .011).

Study Conclusion:

The authors concluded that finasteride use is associated with the improved overall survival in patients with bladder cancer and call for further randomized controlled trials in this area.

Reference

Garg H et al. Impact of Finasteride on Survival in Bladder Cancer: A Retrospective Multi-institutional Database Analysis. Clin Genitourin Cancer. 2022 Oct 29;S1558-7673(22)00221-X.