Effect Of α1-Adrenoceptor Antagonist Exposure On Prostate Cancer Incidence: An Observational Cohort Study

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Men's health;  Clinical Trials / Drug Trials
Article Date: 21 Nov 2007 - 0:00 PDT

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UroToday.com- In the November issue of the Journal of Urology, Dr. Harris and associates report that the use of alpha-1-adrenorecoptor antagonist's terazosin, prazosin, and doxazosin decrease the incidence of prostate cancer (CaP). Terazosin and doxazosin are used in the treatment of BPH and hypertension. Alpha-1-adrenorecoptor antagonists inhibit the receptors in smooth muscle decreasing smooth muscle tone in the prostatic urethra and bladder neck. However, it is also recognized that these drugs induce apoptosis and decrease angiogenesis. The authors hypothesized that terazosin, prazosin, and doxazosin may have a chemopreventive role for CaP.

They performed an observational cohort study using the Lexington VA Hospital database of male patients between 1998 and 2003. Clinical, demographic and pathologic data was collected. A total of 623 cases of CaP were identified and 4,198 men were found to have been treated with terazosin, prazosin or doxazosin. Linkage found 67 alpha-blocker users to have been diagnosed with CaP 2 months or more after initiating alpha-blocker therapy. There were 4,003 men on alpha-blockers who did not have a diagnosis of CaP.

The researchers found that 67 of the 4,070 men treated with alpha-blockers were found to have CaP, compared to 556 incident cases diagnosed among 23,068 unexposed men during the study period. The alpha-blocker users had a CaP cumulative incidence of 1.65%, compared to 2.41% in the unexposed group, for an unadjusted risk ratio of 0.682. This indicates that use of alpha-blockers resulted in a 1.46 times lower relative risk and 31.7% lower attributable risk for CaP than unexposed men. This translates to 7.6 fewer CaP cases per 1,000 treated men. Alpha-blocker use was not associated with a different overall survival, although the authors note that age may have been a potential confounder regarding this association.

The authors conclude this interesting study with a call for further investigation into this potential chemopreventive relationship between alpha-blockers and CaP.

Harris AM, Warner BW, Wilson JM, Becker A, Rowland RG, Conner W, Lane M, Kimbler K, Durbin EB, Baron AT, Kyprianou N

J Urol. 178(5): 2176-2180, November 2007
doi: 10.1016/j.juro.2007.06.043

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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