Use of a nonselective beta-blocker at the time of radical prostatectomy (RP) may reduce the risk for prostate cancer recurrence, investigators suggest.
In a study of 11,117 treatment-naïve patients with prostate cancer underwent RP in Norway from 2008 to 2015, nonselective beta-blocker use at the time of RP was significantly associated with a 36% lower risk of treatment for prostate cancer recurrence, corresponding author Kristin Austlid Taskén, PhD, of the Institute of Cancer Research at Oslo University Hospital in Oslo, Norway, and colleagues reported in JAMA Network Open. Recurrence was defined as initiation of hormonal therapy, radiation therapy, chemotherapy or, if no treatment was identified, cancer-specific mortality. No association was observed for use of selective beta-blockers.
Patients receiving treatment for recurrence in the first 6 months of RP were excluded from the study to minimize the influence of surgical failure or occult metastasis, which may have introduced selection bias. An important study limitation was the lack of postoperative PSA values. In the study, median use of nonselective beta-blockers was more than 4 years.
Nonselective beta-blockers might counteract prostate cancer recurrence associated with perioperative stress and catecholamine, the investigators suggested. Increased catecholamine levels as a result of surgical tissue trauma, anesthetic agents, and psychological stress may affect cancer cell plasticity, the surrounding vasculature, and the immune cell landscape, promoting metastasis and growth of residual disease, the investigators explained.
“With the high volumes of RPs being performed, even a small delay in the need for further hormonal therapy and radiotherapy after surgery would justify an interventional study to identify a potential causality between [nonselective beta-blocker] use and prostate cancer recurrence,” Dr Taskén’s team wrote.
Beta-blockers treat hypertension, cardiovascular disorders, migraine, hyperthyroidism, glaucoma, anxiety, and other common disorders. Nonselective beta-blockers (eg, propranolol, nadolol, timolol, and pindolol) act on both β1- and β2-adrenergic receptors, whereas selective beta-blockers target mainly β1-adrenergic receptor.