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  3. Use of 5α-reductase inhibitors for lower urinary tract symptoms and risk of prostate cancer in Swedish men: nationwide, population based case-control study
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Research

Use of 5α-reductase inhibitors for lower urinary tract symptoms and risk of prostate cancer in Swedish men: nationwide, population based case-control study

BMJ 2013; 346 doi: https://doi.org/10.1136/bmj.f3406 (Published 18 June 2013) Cite this as: BMJ 2013;346:f3406
  1. David Robinson, researcher12,
  2. Hans Garmo, senior medical statistician36,
  3. Anna Bill-Axelson, associate professor4,
  4. Lorelei Mucci, associate professor5,
  5. Lars Holmberg, professor36,
  6. Pär Stattin, professor17
  1. 1Department of Surgery and Perioperative Sciences, Urology, and Andrology, Umeå University, 901 85 Umeå, Sweden
  2. 2Department of Urology, Ryhov County Hospital, 551 85 Jönköping, Sweden
  3. 3Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden
  4. 4Department of Surgical Sciences, Urology, Uppsala University, Uppsala, Sweden
  5. 5Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
  6. 6King’s College London, Medical School, Division of Cancer Studies, Cancer Epidemiology Group, London, UK
  7. 7Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
  1. Correspondence to: D Robinson drobinson{at}telia.com
  • Accepted 17 May 2013

Abstract

Objective To assess the association between 5α-reductase inhibitor (5-ARI) use in men with lower urinary tract symptoms and prostate cancer risk.

Design Nationwide, population based case-control study for men diagnosed with prostate cancer in 2007-09 within the Prostate Cancer data Base Sweden 2.0.

Setting The National Prostate Cancer Register, National Patient Register, census, and Prescribed Drug Register in Sweden, from which we obtained data on 5-ARI use before date of prostate cancer diagnosis.

Participants 26 735 cases and 133 671 matched controls; five controls per case were randomly selected from matched men in the background population. 7815 men (1499 cases and 6316 controls) had been exposed to 5-ARI. 412 men had been exposed to 5-ARI before the diagnosis of a cancer with Gleason score 8-10.

Main outcome measures Risk of prostate cancer calculated as odds ratios and 95% confidence intervals by conditional logistic regression analyses.

Results Risk of prostate cancer overall decreased with an increasing duration of exposure; men on 5-ARI treatment for more than three years had an odds ratio of 0.72 (95% confidence interval 0.59 to 0.89; P<0.001 for trend). The same pattern was seen for cancers with Gleason scores 2-6 and score 7 (both P<0.001 for trend). By contrast, the risk of tumours with Gleason scores 8-10 did not decrease with increasing exposure time to 5-ARI (for 0-1 year of exposure, odds ratio 0.96 (95% confidence interval 0.83 to 1.11); for 1-2 years, 1.07 (0.88 to 1.31); for 2-3 years, 0.96 (0.72 to 1.27); for >3 years, 1.23 (0.90 to 1.68); P=0.46 for trend).

Conclusions Men treated with 5-ARI for lower urinary tract symptoms had a decreased risk of cancer with Gleason scores 2-7, and showed no evidence of an increased risk of cancer with Gleason scores 8-10 after up to four years’ treatment.

Footnotes

  • This project was made possible by the continuous work of the National Prostate Cancer Register of Sweden steering group: Pär Stattin (chair), Anders Widmark, Lars Egevad, Magnus Törnblom, Stefan Carlsson, Jan Adolfsson, Anna Bill-Axelson, Jan-Erik Johanssson, Ove Andreen, Mats Lambe, Erik Holmberg, David Robinson, Bill Pettersson, Jonas Hugosson, Jan-Erik Damber, Maria Nygren, Ola Bratt, and Göran Ahlgren.

  • Contributors: DR, HG, LH, and PS designed the study, analysed and interpreted the data, and drafted the manuscript. LM and AB-A contributed to the study design, analysis, and interpretation of the data. All authors made substantial contributions to drafts of the manuscript, had full access to all data (including statistical reports and tables) in the study, and take responsibility for the integrity of the data and the accuracy of the data analysis. DR and PS are guarantors.

  • Funding: This study was funded by the Swedish Research Council (2010-5950); the Swedish Cancer Society (11 0471, 11 0718); the Lion’s Cancer Research Foundation, Umeå University Hospital; Futurum, Jönköping county council; and the Cancer Research Foundation, Jönköping. None of these funders had any part in the collection, management, analysis, interpretation of the data and not in preparation, review, or approval of the manuscript.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The study was approved by the research ethics board at Umeå University Hospital (2011-53-31M).

  • Data sharing: No additional data available.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.

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