Abstract
There is evidence that a history of benign prostatic hyperplasia increases the incidence of bladder cancer, and treatment with 5-alpha reductase inhibitor or androgen deprivation therapy reduces recurrence of non-muscle invasive bladder cancer. We aimed to evaluate whether prostate volume affects its prognosis. We reviewed medical records of men who underwent transurethral resection of bladder tumor due to non-muscle invasive bladder cancer from January 2012 to December 2017. Patients were divided into two groups based on prostate volume measured by computed tomography (group 1: 264 patients with ≤ 30 mL, group 2: 124 patients with > 30 mL). Propensity score matching analysis was used for adjust selection bias, and then assessed recurrence-free survival and progression-free survival. With a median follow up duration of 52 months, group 1 showed higher 5-year recurrence-free and progression-free survival (69.3% vs 47.0%, p = 0.001; 96.7% vs 87.7%, p = 0.002). Further, cox-regression analysis showed that tumor size (HR = 1.292 p < 0.001), multifocal tumor (HR = 1.993, p < 0.001), adjuvant intravesical therapy (chemotherapy: HR = 0.580, p = 0.037 and bacillus Calmette–Guérin: HR = 0.542, p = 0.004) and prostate volume (HR = 2.326, p < 0.001) were significant predictors of recurrence-free survival. Prostate volume (HR = 2.886, p = 0.014) was also associated with PFS with age (HR = 1.043, p = 0.044) and tumor grade (HR = 3.822, p = 0.013). We conclude higher prostate volume is associated with worse recurrence and progression-free survival in non-muscle invasive bladder cancer.
Highlights
There is evidence that a history of benign prostatic hyperplasia increases the incidence of bladder cancer, and treatment with 5-alpha reductase inhibitor or androgen deprivation therapy reduces recurrence of non-muscle invasive bladder cancer
After propensity score matching (PSM), there was no difference in all variables between two groups
Multivariable cox-regression analysis showed that tumor size and multifocal tumor occurrence (HR = 1.838, 95% CI = 1.251–2.700, p = 0.002) were associated with recurrence-free survival (RFS)
Summary
There is evidence that a history of benign prostatic hyperplasia increases the incidence of bladder cancer, and treatment with 5-alpha reductase inhibitor or androgen deprivation therapy reduces recurrence of non-muscle invasive bladder cancer. We conclude higher prostate volume is associated with worse recurrence and progression-free survival in non-muscle invasive bladder cancer. Other studies have shown that using 5-alpha reductase inhibitors (5-ARI) in BPH or androgen deprivation therapy (ADT) in prostate cancer reduces recurrence of bladder cancer[11,12]. Some studies reported AR plays roles in the development of B PH15 Based on these studies PV might be the indicator reflect AR and we aimed to assess if PV as an indicator associated with AR is a potential prognostic factor for NMIBC. Characteristics Age (median, IQR) BMI (median, IQR) Smoking Non-smoker Current or former smoker Tumor size (median, IQR) Multifocal tumor Tumor grade Low grade High grade Pathologic T stage pTa pT1 Tumor variant CIS Immediate intravesical therapy Adjuvant intravesical therapy No Chemotherapy BCG
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