Michael Liss

MD, MAS

University of Texas Health Science Center San Antonio

Assistant Professor

PLCO (Learn more about this study)

PLCO-120

Dec 16, 2014

The Influence of Self-Reported Finasteride Use on the Incidence of Renal Cancer

Although kidney cancer is an important public health problem, it remains an understudied target for cancer prevention and control. In the U.S, it is the 5thth most common cancer in men and the 7th most common cancer in women, with an estimated 65,000 new cases diagnosed annually. The incidence of renal cell carcinoma (RCC) in the U.S. has increased significantly over the last decade, with rates that rose by 3.1% per year from 2005 to 2009.1, 2 In addition, despite improvements in detection and treatment, RCC remains a potentially lethal cancer, with a 5-year disease-specific mortality of 29%.3

Because RCC effects men nearly two fold more than when, androgens have been suspected to be involved in initiation of RCC. While the androgen receptor has been investigated for many years, results have been mixed. Additionally, obesity is a prominent risk factor for incident and prevalent RCC.4 An estimated 30-50% of RCC cases are associated with obesity, and obesity is also a modulator of hormone alterations.3, 5 Male gender and obesity both have implications regarding interactions with androgen receptor based on its interaction with testosterone and dihydrotestoterone (DHT).

Currently, studies have shown that higher AR expression is found in normal kidney (90%) compared to RCC (30%) and that AR Expression is associated with pT stage and Furman grade.6 A recent publication has linked the androgen receptor to inducing HIF-2alpha/VEGF signaling, which corresponds on step upstream target than the current VEGF targeting chemotherapy tyrosine kinas inhibitors.7

Finasteride is a 5 alpha-reductase inhibitor, which block the conversion of testosterone to the more potent dihydrotestosterone. The effect of finasteride on androgen receptors have been mixed though it is not fully understood the interaction of androgen receptor presence compared to AR function based an unknown possible mutations in the AR gene. Herein, we investigate the role of self-reported finasteride use in the PLCO as it relates to the incidence of renal cell cancer in the PLCO.

Aim 1: To determine if finasteride use reduces or delays the incidence of renal cancer in men enrolled in the PLCO trial.
Hypothesis: Self-reported use of Finasteride reduces the incidence of renal cancer.

Aim 2: To determine if finasteride invokes a dose-dependent response to the incidence of renal cancer controlling for factors such as smoking, diabetes, and obesity in men.
Hypothesis: The longer finasteride was used determined by follow up questionnaires was more like to cause reduction in renal cancer as compared to those men with less exposure.