Department of Urology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
Department of Urology, Albert Einstein College of Medicine / Montefiore Medical Center, Bronx, NY.
Urol Oncol. 2020 Oct;38(10):794.e11-794.e16. doi: 10.1016/j.urolonc.2020.03.024. Epub 2020 Apr 17.
Increased adrenergic innervation is observed in prostate cancer (CaP) and is associated with aggressive disease. Emerging evidence suggests that beta-adrenergic blockade inhibits CaP progression. However, the association between type of beta-blocker use and risk of incident CaP on initial prostate biopsy has not been investigated in multiethnic populations.
A retrospective study of racially/ethnically diverse men (64% African-American and Hispanic), who underwent initial prostate biopsy between 2006 and 2016 in a large healthcare system was performed. Oral use of beta-blocker type was assessed by reviewing active prescriptions within the 5-year period preceding initial biopsy. Patient demographics and clinical factors were collected.
Of 4,607 men who underwent initial prostate biopsy, 4,516 met criteria and 2,128 had a biopsy positive for CaP; 20% high-risk, 41% intermediate-risk, and 39% low or very-low risk (National Comprehensive Cancer Network classification). Overall, 15% of patients were taking a beta-blocker prior to initial biopsy, with Metoprolol, Atenolol, and Carvedilol accounting for the majority. Of beta-blocker types, Atenolol alone was associated with a 38% reduction in odds of incident CaP (P= 0.01), with a 40% and 54% reduction in risks of National Comprehensive Cancer Network intermediate and high-risk CaP (P = 0.03 and P = 0.03, respectively) compared to men not taking a beta-blocker. Furthermore, longer duration of Atenolol use (3-5 years) was associated with a 54% and 72% reduction in intermediate and high-risk disease, (P = 0.03 and P = 0.03, respectively).
Among beta blocker types, long-term Atenolol use is associated with a significant reduction in incident CaP risk on initial prostate biopsy for clinically-significant intermediate and high-risk disease compared to men not taking a beta-blocker.
在前列腺癌（CaP）中观察到肾上腺素能神经支配增加，并且与侵袭性疾病相关。新出现的证据表明，β-肾上腺素能阻断可抑制 CaP 的进展。但是，在多民族人群中，尚未研究使用β受体阻滞剂的类型与初始前列腺活检时 CaP 发病风险之间的关系。
对 2006 年至 2016 年间在一家大型医疗机构中接受初始前列腺活检的种族/族裔多样化男性（64%为非裔美国人和西班牙裔）进行了回顾性研究。在初始活检前的 5 年期间，通过审查活性处方来评估口服β受体阻滞剂类型。收集了患者的人口统计学和临床因素。
在 4607 名接受初始前列腺活检的男性中，有 4516 名符合标准，有 2128 名活检阳性诊断为 CaP；20%为高危，41%为中危，39%为低危或极低危（国家综合癌症网络分类）。总体而言，在初始活检前，有 15%的患者正在服用β受体阻滞剂，其中美托洛尔、阿替洛尔和卡维地洛占大多数。在β受体阻滞剂类型中，仅阿替洛尔可使 CaP 发病的几率降低 38%（P=0.01），与未服用β受体阻滞剂的男性相比，中危和高危 CaP 的风险分别降低了 40%和 54%（P=0.03 和 P=0.03）。此外，阿替洛尔使用时间较长（3-5 年）与中危和高危疾病的风险降低 54%和 72%相关（P=0.03 和 P=0.03）。
在β受体阻滞剂类型中，与未服用β受体阻滞剂的男性相比，长期使用阿替洛尔与初始前列腺活检时中危和高危疾病的 CaP 发病风险显著降低相关。
