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Sex steroids and gender differences in nonmuscle invasive bladder cancer

Lucca, Ilariaa,b; Fajkovic, Haruna; Klatte, Tobiasa

doi: 10.1097/MOU.0000000000000092

Purpose of review To review and summarize current knowledge on gender differences and sex steroid hormones in nonmuscle invasive bladder cancer.

Recent findings Beyond the proven role of gender as a risk factor for the development of bladder cancer, recent studies indicate that women present with more advanced bladder cancer tumor stages than men, which may be due to differences in both bladder cancer care and biology. In addition, female gender has been identified as an independent prognostic factor for both recurrence and progression and may be associated with worse response to Bacillus Calmette–Guérin instillation therapy. Overall, sex steroid hormones and their receptors impact bladder carcinogenesis, recurrence and progression. Basic and transitional research evidence suggests that estrogens may initially protect against bladder cancer development, but later promote bladder cancer progression. Androgens, in contrast, seem to initiate and drive bladder cancer with its receptor playing a central role. Promising novel research shows a potential role of sex steroid hormones as therapeutic targets.

Summary Whereas men are more likely to develop bladder cancer, women present generally with more advanced disease and have worse oncologic outcomes even after adjusting for tumor stage. Sex steroid hormones and their receptors play an active role in bladder cancer development and progression and represent attractive therapeutic targets for gender-specific care.

aDepartment of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria

bDepartment of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Correspondence to Tobias Klatte, Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Tel: +43 1 40400 2602; fax: +43 1 40400 2332; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins