Impact of Renin-Angiotensin System Inhibitors on Disease Characteristics in Patients with Localized Prostate Cancer Treated with Radical Prostatectomy: A European Association of Urology Young Academic Urologists Prostate Cancer Working Group Multi-institutional Study

Inhibitors of the renin-angiotensin system are frequently prescribed for antihypertension therapy and can affect cancer aggressiveness by inhibiting collagen synthesis in several different cancers. However, our study findings for a large cohort of 1250 patients indicate that use of this medication class does not influence the aggressiveness of prostate cancer. Collagen biosynthesis is intricately involved in the development and progression of solid tumors. Renin-angiotensin system inhibitors (RASi) impede TGF-β-mediated collagen synthesis in tumors by hindering activation of the angiotensin receptor. Our aim was to investigate a potential association between RASi use and the aggressiveness of prostate cancer (PCa). We conducted a retrospective multicenter analysis for a cohort of 1250 patients with PCa who underwent radical prostatectomy (RP) between 1990 and 2023 in four European high-volume centers. The study cohort comprised 625 RASi-treated patients and 625 age-matched RASi-naïve patients. Data for various parameters were collected, including age at RP, body mass index (BMI), prostate volume, prostate-specific antigen (PSA), percentage of free PSA, Gleason score (GS) at biopsy and RP, TNM stage, and the rate of biochemical recurrence (BCR). Clinical parameters for patients with and without RASi treatment were documented. Differences between the groups were compared using a Mann-Whitney U test and χ2 tests. Survival analyses were performed using the Kaplan-Meier method. As expected, the RASi group had higher BMI levels than the RASi-naïve group (p