Background α1-antagonists are commonly used to treat benign prostatic hyperplasia. Preclinical studies suggest they induce cell death and inhibit tumor growth. This study evaluates the risk of prostate cancer death in men using α1-antagonists. Methods A population-based cohort study in Stockholm, Sweden (January 1, 2007 to December 31, 2019) including 451,779 men with a prostate-specific antigen (PSA) test. Study entry was one year after the first PSA test. Men were considered exposed at their second filled prescription. Primary outcome: prostate cancer mortality. Secondary outcomes: all-cause mortality and prostate cancer incidence. Cox proportional hazard regression models were used to calculate adjusted hazard ratios (HRs) and 95% CIs for all outcomes. Inverse probability weighting with marginal structural models accounted for time-dependent confounders. Results Of 351,297 men in the cohort, 39,856 (11.3%) were exposed to α1-antagonists. Median follow-up for prostate cancer mortality was 8.9 years and median exposure time to α1-antagonists was 4.4 years. There was no evidence of an association between α1-antagonist use and prostate cancer mortality, all-cause mortality, or high-grade prostate cancer. α1-antagonist-use was associated with an increased risk of prostate cancer (HR: 1.11, 95% CI: 1.06—1.17) and low-grade prostate cancer (HR: 1.22, 95% CI: 1.11—1.33). Men treated with α1-antagonists had more frequent PSA testing. Conclusions Our findings show no significant association between α1-adrenoceptor antagonist exposure and prostate cancer mortality or high-grade prostate cancer. Although the preclinical evidence indicates a potential chemopreventive effect, this study’s findings do not support it.

中文翻译：

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接触 α1-肾上腺素受体拮抗剂的男性的前列腺癌发病率和死亡率

背景 α1-拮抗剂通常用于治疗良性前列腺增生。临床前研究表明它们会诱导细胞死亡并抑制肿瘤生长。这项研究评估了使用 α1 拮抗剂的男性患前列腺癌死亡的风险。方法 在瑞典斯德哥尔摩进行的一项基于人群的队列研究（2007 年 1 月 1 日至 2019 年 12 月 31 日），包括 451,779 名接受前列腺特异性抗原 (PSA) 测试的男性。研究进入时间为第一次 PSA 测试一年后。男性在第二次配药时就被认为暴露了。主要结局：前列腺癌死亡率。次要结局：全因死亡率和前列腺癌发病率。 Cox 比例风险回归模型用于计算所有结果的调整后风险比 (HR) 和 95% CI。边际结构模型的逆概率加权可以解释与时间相关的混杂因素。结果 在队列中的 351,297 名男性中，有 39,856 名 (11.3%) 接触过 α1 拮抗剂。前列腺癌死亡率的中位随访时间为 8.9 年，α1 拮抗剂的中位暴露时间为 4.4 年。没有证据表明α1拮抗剂的使用与前列腺癌死亡率、全因死亡率或高级别前列腺癌之间存在关联。使用α1拮抗剂与前列腺癌（HR：1.11，95％CI：1.06-1.17）和低级别前列腺癌（HR：1.22，95％CI：1.11-1.33）风险增加相关。使用 α1 拮抗剂治疗的男性进行了更频繁的 PSA 检测。结论 我们的研究结果表明，α1-肾上腺素受体拮抗剂暴露与前列腺癌死亡率或高级别前列腺癌之间没有显着相关性。尽管临床前证据表明具有潜在的化学预防作用，但本研究的结果并不支持这一点。