BACKGROUND Spironolactone, a cheap effective diuretic used to manage hypertension and heart failure, also has anti-androgenic effects through its non-selective binding to steroid receptors, and hence may affect prostate cancer (PCa) risk. This study investigated the association between spironolactone use and PCa risk. For comparison, we also examined associations with thiazide diuretics which do not have anti-androgenic properties. METHODS A matched case-control study was undertaken using population-wide data from the Prostate Cancer Data Base Sweden (PCBaSe). All PCa cases diagnosed from 2014 to 2016 were matched by birth year and county with PCa-free controls selected from the general population (1:5). Multivariable conditional logistic regression was used to examine associations between spironolactone use (dose and duration) and PCa risk, and similarly for thiazides. RESULTS Three percent of the 31,591 cases and 4% of the 156,802 controls had been prescribed spironolactone. Multivariable analyses indicated reduced risk of PCa among those ever exposed to spironolactone (odds ratio [OR] 0.83; 95% confidence interval [CI]: 0.76-0.89), with a stronger association for current users (OR: 0.77, 95% CI: 0.69-0.86) than past users (OR: 0.88; 95% CI: 0.79-0.97) and decreasing risk with increasing dose (p-trend < 0.001). No association was observed for thiazide exposure and PCa risk. Biases due to differences in prescribing patterns or frequency of PSA testing may have influenced these findings. CONCLUSION PCa risk was reduced among men exposed to the diuretic spironolactone. Further investigation of spironolactone's potential chemopreventive effects is warranted.

中文翻译：

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螺内酯的使用与较低的前列腺癌风险相关：一项全人群病例对照研究。

背景螺内酯是一种用于治疗高血压和心力衰竭的廉价有效利尿剂，也通过其与类固醇受体的非选择性结合而具有抗雄激素作用，因此可能会影响前列腺癌 (PCa) 的风险。本研究调查了螺内酯的使用与 PCa 风险之间的关联。为了进行比较，我们还检查了与不具有抗雄激素特性的噻嗪类利尿剂的关联。方法 使用来自瑞典前列腺癌数据库 (PCBaSe) 的全人群数据进行了匹配的病例对照研究。2014 年至 2016 年诊断出的所有 PCa 病例均按出生年份和县与从一般人群中选择的无 PCa 对照 (1:5) 进行匹配。多变量条件逻辑回归用于检查螺内酯使用（剂量和持续时间）与 PCa 风险之间的关联，噻嗪类药物也是如此。结果 31,591 例病例中的 3% 和 156,802 例对照者中的 4% 服用了螺内酯。多变量分析表明，曾接触过螺内酯的人患 PCa 的风险降低（比值比 [OR] 0.83；95% 置信区间 [CI]：0.76-0.89），与当前用户的相关性更强（OR：0.77，95% CI： 0.69-0.86) 比过去的使用者 (OR: 0.88; 95% CI: 0.79-0.97) 和风险随着剂量增加而降低 (p-trend < 0.001)。未观察到噻嗪类药物暴露与 PCa 风险之间存在关联。由于处方模式或 PSA 测试频率的差异而导致的偏差可能影响了这些发现。结论 暴露于利尿剂螺内酯的男性的 PCa 风险降低。有必要进一步研究螺内酯的潜在化学预防作用。