Whyne Erum Z, Jeon-Slaughter Haekyung, Kelly Katherine, Dowell Jonathan E
Research Service, VA North Texas Health Care System, Dallas, Texas, USA.
Pharmacy Service, VA North Texas Health Care system, Dallas, Texas, USA.
Prostate. 2025 Feb;85(2):148-155. doi: 10.1002/pros.24811. Epub 2024 Oct 28.
Prostate cancer is the most common cancer in men in the United States with low survival rates once metastasized. Abiraterone is approved for use in castrate-sensitive and castrate-resistant prostate cancer and is used extensively in the Veterans Affairs (VA) healthcare system. Spironolactone, a diuretic used to treat heart failure, edema, ascites, and hypertension, may increase androgen levels and reduce effectiveness of abiraterone when used concurrently to treat prostate cancer patients. While previous case studies support this, no large epidemiology studies have been conducted. The current study utilizes the large, VA prostate cancer data core and evaluates the effect of concomitant spironolactone on efficacy of abiraterone treatment in metastatic prostate cancer patients.
The study selected 18,943 veterans with metastatic prostate cancer on abiraterone treatment. Of these, 581 patients (3.1%) were also on concomitant spironolactone. The concomitant treatment group, abiraterone + spironolactone, significantly differed from the abiraterone-only group in body mass index, prevalence rates of heart failure and liver disease, and being previously treated with docetaxel. A 1:1 propensity score matching method was used to balance sample sizes and baseline traits between the two treatment groups, abiraterone versus abiraterone + spironolactone. Kaplan-Meier curves and Cox proportional hazard model were used to compare 5-year overall survival and all-cause mortality outcomes, respectively, between the two groups.
After propensity score matched, the abiraterone + spironolactone group was treated with abiraterone significantly longer than the abiraterone-only group (mean ± standard deviation days 549.0 ± 552.3 vs. 435.5 ± 474.1; p = 0.0002) and had a higher 5-year overall survival rate (44% vs. 37%; p = 0.0116). Veterans with metastatic prostate cancer treated with abiraterone + spironolactone also had a lower 5-year all-cause mortality compared to those only on abiraterone (hazard ratio 0.80, 95% confidence intervals 0.61-0.96; p = 0.012).
This large VA observational study suggests that concomitant use of spironolactone does not compromise cancer control or survival of metastatic prostate cancer patients treated with abiraterone.
前列腺癌是美国男性中最常见的癌症，一旦发生转移，生存率较低。阿比特龙被批准用于治疗去势敏感性和去势抵抗性前列腺癌，并在退伍军人事务（VA）医疗系统中广泛使用。螺内酯是一种用于治疗心力衰竭、水肿、腹水和高血压的利尿剂，在与阿比特龙同时用于治疗前列腺癌患者时，可能会增加雄激素水平并降低阿比特龙的疗效。虽然之前的病例研究支持这一点，但尚未进行大规模的流行病学研究。本研究利用VA庞大的前列腺癌数据核心，评估螺内酯与阿比特龙联合使用对转移性前列腺癌患者阿比特龙治疗疗效的影响。
该研究选取了18943名接受阿比特龙治疗的转移性前列腺癌退伍军人。其中，581名患者（3.1%）同时使用了螺内酯。联合治疗组（阿比特龙+螺内酯）在体重指数、心力衰竭和肝病患病率以及既往是否接受多西他赛治疗方面与单纯阿比特龙组存在显著差异。采用1:1倾向评分匹配方法来平衡两个治疗组（阿比特龙组与阿比特龙+螺内酯组）的样本量和基线特征。分别使用Kaplan-Meier曲线和Cox比例风险模型比较两组的5年总生存率和全因死亡率结果。
倾向评分匹配后，阿比特龙+螺内酯组接受阿比特龙治疗的时间明显长于单纯阿比特龙组（平均±标准差天数为549.0±552.3天 vs. 435.5±474.1天；p = 0.0002），且5年总生存率更高（44% vs. 37%；p = 0.0116）。与仅接受阿比特龙治疗的患者相比，接受阿比特龙+螺内酯治疗的转移性前列腺癌退伍军人的5年全因死亡率也更低（风险比0.80，95%置信区间0.61 - 0.96；p = 0.012）。
这项大型VA观察性研究表明，同时使用螺内酯不会影响接受阿比特龙治疗的转移性前列腺癌患者的癌症控制或生存率。
