Switching cancers: a systematic review assessing the role for androgen suppressive therapy in bladder cancer

Kassim Kourbanhoussen, Catherine McMartin, Michele Lodde, Alexandre Zlotta, Rik Bryan, Paul Toren

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Abstract

Context
Bladder cancer demonstrates striking gender-based differences in incidence, with a role for androgens possibly implicated in the development and progression of the disease. Emerging preclinical and clinical evidence suggests that there may be a role for antiandrogen therapy in bladder cancer.

Objective
This systematic review assessed the current clinical evidence evaluating androgen suppressive therapy (AST) for the treatment or prevention of bladder cancer.

Evidence acquisition
Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, MEDLINE was searched for full-text articles detailing clinical outcomes or incidence of bladder cancer among patients who received AST, defined as gonadotropin-releasing hormone agonists or equivalent, androgen receptor antagonists, or 5-alpha reductase inhibitors.

Evidence synthesis
A total of 12 studies were included. Five studies focused on prostate cancer patients, with one study in men with lower urinary tract symptoms. Among these studies, a lower incidence of bladder cancer was observed in five, with adjusted risk reduction estimates ranging from 7% to 47%. Six studies evaluating 11 820 bladder cancer patients investigated clinical outcomes among men who received a form of AST. Three out of four studies evaluating recurrence-free survival found a benefit for AST, with adjusted hazard ratios for recurrence of non–muscle-invasive cancer ranging from 0.29 to 0.53. Limitations included large variability in data sources and methodologies, as well as no data on tolerability.

Conclusions
Current evidence indicates that antiandrogen therapies exert a favorable influence on bladder tumors. Further prospective studies are needed to assess their therapeutic potential.

Patient summary
Androgen suppressive therapy is commonly prescribed for the treatment of prostate-related problems. Prior research indicates that there may be a role for these treatments in patients with bladder cancer. In this review, we evaluate the current evidence that strongly suggests that these agents may be effective against bladder cancer.
Original languageEnglish
Pages (from-to)1044-1051
Number of pages8
JournalEuropean Urology Focus
Volume7
Issue number5
Early online date30 Oct 2020
DOIs
Publication statusPublished - 25 Sept 2021

Bibliographical note

Funding Information:
Funding/Support and role of the sponsor: Paul Toren was supported by a clinician-scientist award from Fonds de Recherche du Québec – Santé (# 32774 ).

Publisher Copyright:
© 2020 European Association of Urology

Keywords

  • Androgen suppression therapy
  • Androgens
  • Bladder cancer
  • Recurrence
  • Incidence
  • Systematic review

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