The emerging role of sex steroid receptors in urothelial bladder cancer

Significant gender differences in the incidence and progression of Urothelial Bladder Cancer (UBC) have been observed widely. Noteworthy among these are, a higher occurrence in males (male to female ratio of 3.5:1), an advanced stage of disease at the time of diagnosis and rapid progression of the disease after initial diagnosis in females than in males. Studies show that the relationship between gender and UBC is complex. Various biological and epidemiological factors have been postulated to be the basis of this causal relationship including the influence of factors like sex steroid hormone pathway, gender difference in environmental carcinogen exposure, metabolic enzyme activity and disparities in the intensity of diagnostic evaluation. In this chapter, we have reviewed the literature to identify the possible role of sex hormone receptors in gender variation and sexual dimorphism in the genesis and progression of UBC. It appears that excessive or reduced expression of sex steroid receptors and the alterations in their upstream or downstream pathways correlated well with clinical and therapeutic outcomes of this cancer entity. The clinical implications of identifying sex steroid receptors in the prognostication of the disease and the potential therapeutic role for anti-Androgens in the prevention and in the mitigation of progression of UBC are critically reviewed.