To interrogate the National Veterans Health Administration (VA) database to determine if beta-blocker use at time of initiation of androgen therapy deprivation (ADT) would result in improved oncological outcomes in advanced prostate cancer.
All men diagnosed with high risk PCa (PSA >20) from 2000-2008 who were on ADT ≥ 6 months were identified. Patients receiving ADT concurrently with primary radiation therapy were excluded. Pharmacy data was interrogated for all beta-blockers, but then focused on the selective beta-1 blocker metoprolol. Cox proportional hazards ratios were calculated for overall survival (OS), PCa specific survival (CSS) and skeletal related events (SREs).
In 39,198 patients with high risk PCa on ADT, use of any beta-blocker was not associated with improvement in OS, CSS, or SREs. Further analyses focusing on metoprolol found that 10,224 (31.9%) had used metoprolol while 21,834 had no beta-blocker use. Multivariable analysis with Inverse Propensity Score Weighting, adjusted for factors including PSA, Gleason score, and duration ADT, found that utilization of metoprolol was not associated with improvement in OS (HR 0.97, p=0.19), CSS (HR 0.94, p=0.23) or SREs (HR 0.98, p=0.79).
In this large cohort, metoprolol use in conjunction with ADT in high risk PCa was not associated with improvement in OS, CSS or risk of SRE. In contrast to a recent smaller clinical study, our data strongly suggests no cancer specific benefit to beta-blocker use in advanced PCa.
Urology. 2021 Feb 12 [Epub ahead of print]
Natasza M Posielski, Kyle A Richards, Jinn-Ing Liou, Tudor Borza, E Jason Abel, Tracy M Downs, David F Jarrard
University of Wisconsin, Department of Urology, 1685 Highland Avenue, 3259 Medical Foundation Centennial Building, Madison, WI 53705; Virginia Mason Hospitals, Department of Urology, 1100 9th Avenue, Seattle, WA 98101., University of Wisconsin, Department of Urology, 1685 Highland Avenue, 3259 Medical Foundation Centennial Building, Madison, WI 53705; William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705., University of Wisconsin, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705., University of Wisconsin, Department of Urology, 1685 Highland Avenue, 3259 Medical Foundation Centennial Building, Madison, WI 53705., University of Wisconsin, Department of Urology, 1685 Highland Avenue, 3259 Medical Foundation Centennial Building, Madison, WI 53705. Electronic address: .