Presentation Authors: Shuo-chieh Wu*, Felix V. Chen, Deukwoo Kwon, Maria C. Velasquez, Sanoj Punnen, Dipen J. Parekh, Chad R. Ritch, Mark L. Gonzalgo, Miami, FL
Introduction: Despite major advancements in the multimodal management of bladder cancer (BC), treatment continues to be challenged by high rates of recurrence and disease progression. Clinical investigations have begun to explore the role of androgen suppression therapy (AST) as an adjunct to BC treatment. We present a single-institution analysis of the association between AST and BC recurrence and progression.
Methods: We included male patients with a diagnosis of non-muscle invasive bladder cancer (NMIBC) from our institutional database. Patient charts were reviewed for history of AST. Subjects who started AST after documented recurrence and/or progression were excluded. BC was classified in accordance with AUA risk stratification guidelines. Hazard ratios (HR) were estimated with a Cox proportional hazards model. Kaplan-Meier analysis and log-rank test were used to compare recurrence-free survival (RFS) and progression-free survival (PFS) between groups.
Results: A total of 274 males met inclusion criteria, including 36 with AST and 238 without AST. Median follow-up was 3.2 years. AST consisted of 5-alpha reductase inhibitor (n = 26), gonadotropin-releasing hormone agonist (n = 10), and antiandrogen (n = 7). Six patients received more than one type of AST. Intravesical recurrence was observed in 47% and 71% of patients, and tumor progressed in 14% and 29% of patients with and without AST, respectively. AST was associated with a significantly lower risk of recurrence (HR 0.52, p = 0.02) as well as improved RFS (p = 0.014). However, no statistically significant reduction of progression (HR 0.61, p = 0.35) or improvement of PFS (p = 0.23) was observed with AST. After risk stratification, high-risk classification was found to be an independent predictor of recurrence (HR 1.55, p < 0.01) and progression (HR 3.38, p < 0.01). Notably, all 5 patients who progressed on AST had high-risk disease, whereas no patients with low/intermediate-risk disease progressed on AST.
Conclusions: In this retrospective, single-institution bladder cancer registry study, AST was associated with a lower risk of recurrence in NMIBC. Further investigation is warranted to define the role of AST as an adjunctive therapy for management of bladder cancer.
Source of Funding: N/A