5-α REDUCTASE INHIBITORS in TREATMENT of BENIGN PROSTATIC HYPERPLASIA

Abstract

Benign prostatic hyperplasia (BPH) is one of the most commonly diagnosed chronic diseases in older men associated with a gradual deterioration of lower urinary tract symptoms (LUTS). 5-α reductase inhibitors (5ARIs) are among the most commonly used pharmacological treatments for BPH(1, 2). They act by inhibiting the enzyme 5α-reductase, promoting prostatic apoptosis and prostate size reduction in order to improve urinary symptoms. Although multiple clinical trials showed 5ARIs could reduce the risk of AUR or need for surgery(3-7), In practice, poor adherence to 5ARIs treatment remains to be a problem, which could lead to a reduced efficacy. The relationship between levels of adherence and long-term clinical outcomes has not been determined. Despite the fact that 5ARIs are widely used for benign prostatic hyperplasia, several preclinical studies have demonstrated that treatment with an anti-androgen such as 5ARIs could potentially decrease the incidence of bladder cancer(8, 9). Limited results from observational studies failed to reach a consensus on whether there was a difference in the incidence of bladder cancer between men who received 5ARIs and those who did not(10, 11). In our study we utilized big data generated from medical claims by the Partners Center for Population Health Evaluation and Research Unit to investigate the effect of 5ARIs therapy on men diagnosed with BPH. In the first part of the study, we focused on evaluation of drug adherence and long-term clinical outcomes. In the second part, we investigated if 5ARIs therapy affect on bladder cancer incidence.