1
|
Niazi T, Kaldany E, Tisseverasinghe S, Malagón T, Bahoric B, McPherson V, Rompre-Brodeur A, Anidjar M. Prophylactic A-Blockers for Radiotherapy-Induced Lower Urinary Tract Symptoms in Men with Prostate Cancer: A Phase III Randomized Trial. Cancers (Basel) 2023; 15:3444. [PMID: 37444553 DOI: 10.3390/cancers15133444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE The present phase III randomized trial assessed the efficacy of prophylactic versus therapeutic α-blockers at improving RI-LUTSs in prostate cancer patients receiving external beam radiotherapy (EBRT). METHODS A total of 148 prostate cancer patients were randomized 1:1 to receive either prophylactic silodosin on day one of EBRT or the occurrence of RI-LUTSs. LUTSs were quantified using the international prostate symptom score (IPSS) at regular intervals during the study. The primary endpoint was the change in the IPSS from baseline to the last day of radiotherapy (RT). Secondary endpoints included changes in IPSS from baseline to 4 weeks and 12 weeks after the start of RT. RESULTS Patient demographics, baseline IPSS, and prescribed radiation doses were balanced between arms. On the last day of RT, the mean IPSS was 14.8 (SD 7.6) in the experimental arm and 15.7 (SD 8.5) in the control arm (p = 0.40). There were no significant differences in IPSSs between the study arms in the intention-to-treat (ITT) analysis at baseline, the last day of RT, and 4 and 12 weeks post-RT. CONCLUSION Prophylactic α-blockers were not effective at significantly reducing RI-LUTSs in prostate cancer patients treated with EBRT. Treating patients with α-blockers at the onset of RI-LUTSs will avoid unnecessary drug exposure and toxicity.
Collapse
Affiliation(s)
- Tamim Niazi
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Edmond Kaldany
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Steven Tisseverasinghe
- Division of Radiation Oncology, Department of Oncology, McGill University, Gatineau, QC J8V 3R2, Canada
| | - Talía Malagón
- Division of Cancer Epidemiology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Boris Bahoric
- Division of Radiation Oncology, Department of Oncology, McGill University, Montreal, QC H3A 0G4, Canada
| | - Victor McPherson
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Alexis Rompre-Brodeur
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| | - Maurice Anidjar
- Division of Urology, Department of Surgery, McGill University, Montreal, QC H3A 0G4, Canada
| |
Collapse
|
2
|
Hart J, Spencer B, McDermott CM, Chess-Williams R, Sellers D, Christie D, Anoopkumar-Dukie S. A Pilot retrospective analysis of alpha-blockers on recurrence in men with localised prostate cancer treated with radiotherapy. Sci Rep 2020; 10:8191. [PMID: 32424131 PMCID: PMC7235269 DOI: 10.1038/s41598-020-65238-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/29/2020] [Indexed: 12/17/2022] Open
Abstract
While alpha-blockers are commonly used to reduce lower urinary tract symptoms in prostate cancer patients receiving radiotherapy, their impact on response to radiotherapy remains unknown. Therefore, this pilot study aimed to retrospectively determine if alpha-blockers use, influenced response to radiotherapy for localised prostate cancer. In total, 303 prostate cancer patients were included, consisting of 84 control (alpha-blocker naïve), 72 tamsulosin and 147 prazosin patients. The main outcomes measured were relapse rates (%), time to biochemical relapse (months) and PSA velocity (ng/mL/year). Recurrence free survival was calculated using Kaplan-Meier analysis. Prazosin significantly reduced biochemical relapse at both two and five-years (2.72%, 8.84%) compared to control (22.61%, 34.52%). Recurrence free survival was also significantly higher in the prazosin group. This remained after multivariable analysis (HR: 0.09, 95% CI: 0.04-0.26, p < 0.001). Patients receiving prazosin had a 3.9 times lower relative risk of biochemical relapse compared to control. Although not statistically significant, tamsulosin and prazosin extended recurrence free survival by 13.15 and 9.21 months respectively. We show for the first time that prazosin may reduce risk of prostate cancer recurrence and delay time to biochemical relapse and provides justification for prospective studies to examine its potential as an adjunct treatment option for localised prostate cancer.
Collapse
Affiliation(s)
- Jordan Hart
- Menzies Health Institute, Griffith University, Queensland, Australia
- School of Pharmacy and Pharmacology, Griffith University, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Briohny Spencer
- Menzies Health Institute, Griffith University, Queensland, Australia
- School of Pharmacy and Pharmacology, Griffith University, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Catherine M McDermott
- Centre for Urology Research, Bond University, Gold Coast, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Russ Chess-Williams
- Centre for Urology Research, Bond University, Gold Coast, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Donna Sellers
- Centre for Urology Research, Bond University, Gold Coast, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - David Christie
- School of Pharmacy and Pharmacology, Griffith University, Queensland, Australia
- Genesis Cancer Care, Gold Coast, Queensland, Australia
- Quality Use of Medicines Network, Griffith University, Queensland, Australia
| | - Shailendra Anoopkumar-Dukie
- Menzies Health Institute, Griffith University, Queensland, Australia.
- School of Pharmacy and Pharmacology, Griffith University, Queensland, Australia.
- Quality Use of Medicines Network, Griffith University, Queensland, Australia.
| |
Collapse
|