Spironolactone, a diuretic used to manage hypertension and heart failure, may lower the risk for prostate cancer (PCa), investigators reported at the European Association of Urology 2020 virtual congress.

The finding is from a matched case-control study comparing 31,591 men diagnosed with PCa from 2014 to 2016 and 156,802 age- and county-matched men without PCa (controls) in Sweden. Kerri Beckmann, PhD, of King’s College London in London, England, and colleagues looked at the effect of spironolactone and thiazide diuretics on PCa risk. Spironolactone, they noted, has an anti-androgenic effect due to its nonselective binding to steroid receptors.

The investigators found that men who had ever used spironolactone had significant 17% decreased odds of PCa. The effect was strongest among current users of the drug, who had significant 23% decreased odds of PCa. Spironolactone exposure was significantly associated with 18% and 22% decreased odds of intermediate- and high-risk PCa, respectively. Spironolactone use had no effect on the risk of metastatic PCa diagnosis.

The investigators found no effect of thiazide diuretics on PCa risk.


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For the study, Dr Beckmann and colleagues used data from the Prostate Cancer Database Sweden. They defined exposure to spironolactone and thiazide diuretics as 2 or more filled prescriptions for the drugs.

The investigators concluded that spironolactone has potential as a PCa chemopreventive agent.

Study strengths include a large population-based sample with data from high-quality registers and simultaneous adjustment for other common medications, the authors stated. They also acknowledged study limitations, including potential bias due to prescribing patterns or frequency of PSA testing. In addition, they said their findings could be explained by a masking effect due to lowering of PSA.

Reference

Beckmann K, Garmo H, Lindahl B, et al. Spironolactone use is associated with lower risk of prostate cancer. Presented at: EAU2020 Virtual Congress; July 17 to 21, 2020. Abstract 118.