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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 盧令一 | 5-α 還原酶抑制劑, 良性攝護腺增生, 以及男性乳癌之風險 | 2015/11/30 下午 04:06:55 | 0 |
| 原 文 | 題 目 | 5-α reductase inhibitors, benign prostatic hyperplasia, and risk of male breast cancer. |
| 作 者 | Robinson D, Garmo H, Holmberg L, Stattin P. | |
| 出 處 | Cancer Causes Control. 26(9):1289-97 | |
| 出版日期 | Sep. 2015 | |
| 評 論 | 過去泌尿科醫師對使用5-α還原酶抑制劑（5-ARI）的顧慮多半集中在是否造成性功能障礙，以及是否影響對攝護腺癌的診斷。美國FDA在2014年針對5-ARI (Finasteride)的使用提到『finasteride與男性乳癌的關聯性目前尚不清楚』（http://www.accessdata.fda.gov/drugsatfda_docs/label/2014/020180s044lbl.pdf）。主要是因為在2個臨床試驗（MTOPS & PCPT）中發現有零星的病例報告認為長期使用finasteride可能與男性乳癌有關。最近的文獻報告則認為兩者之間無直接的關聯性。瑞典與英國的醫師則針對從瑞典資料庫中自2006到2008三年間，追蹤將近12.5萬名BPH患者（分別接受5-α還原酶抑制劑、甲型阻斷劑或TURP治療），並對照54.5萬非BPH患者，發現是否接受5-α還原酶抑制劑治療與罹患乳癌的機會並沒有相關性，反倒是意外發現BPH接受TURP後，罹患乳癌的機率反而有意義的增加，作者認為可能是接受TURP的病患大多屬於嚴重的BPH(with BOO)，其testosterone/estrogen ratio 可能較接受5-α 還原酶抑制劑治療者為低（5-ARI 阻斷70%以上的testosterone to DHT），可能是其中一個原因。但是乳癌最重要的成因例如基因、肥胖等，本文並沒有再深入分析其相關性。另外可能為了避免爭議，本文也沒有針對常用的兩種5-ARI做單獨的分析。 | |
| abstract |
PURPOSE: 5-α reductase inhibitors (5-ARI) have been suggested to increase the risk of male breast cancer. The aim of this study was to study the risk of breast cancer in men on 5-ARI, in men with benign prostatic hyperplasia (BPH) not on 5-ARI, and in men without BPH. METHODS: We performed a population-based cohort study in Sweden with data from The Prescribed Drug Register, The Patient Register, and The Cancer Register. Men on 5-ARI, men on α-blockers, or men who had undergone a transurethral resection of the prostate (TUR-P) prior to or during 2006-2008 were included as exposed to BPH and a specific treatment thereof. For each exposed man, five unexposed men were ed. Risk of breast cancer was calculated in Cox proportional hazard models. RESULTS: There were 124,183 exposed men and 545,293 unexposed men, and during follow-up (median 6 years), 99 men with breast cancer were diagnosed. Compared to unexposed men, men on 5-ARI had a hazard ratio (HR) of breast cancer of 0.74 (95 % confidence interval (CI) 0.27-2.03), men on α-blockers had HR 1.47 (95 % CI 0.73-2.95), and men with a TUR-P had HR 1.99 (95 % CI 1.05-3.75). CONCLUSION: No increased risk of breast cancer was observed for men on 5-ARI. However, the increased risk of breast cancer among men who had undergone a TUR-P, a strong indicator of BPH, suggests that the endocrine milieu conducive to BPH is associated with male breast cancer. |
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