Perioperative analgesia may improve prostate cancer outcomes

By Sara Freeman, medwireNews Reporter

Neuraxial (spinal or epidural) analgesia (NA) added to general anesthesia (GA) for radical retropubic prostatectomy (RRP) may lead to improved oncologic outcomes in prostate cancer, US researchers have found.

Patients who received GA alone were more than twice as likely as those who had additional NA to experience systemic cancer progression (hazard ratio [HR] = 2.81) over a median follow-up of 9 years. Patients given GA alone were also more likely to die from any cause (HR=1.32).

“Although not statistically significant, similar findings were observed for the outcome of prostate cancer deaths,” Juraj Sprung, of the Mayo Clinic in Cleveland, Ohio, and colleagues report in the British Journal of Anaesthesia.

However, there was no effect of anesthesia type on cancer recurrence in univariate or multivariate analysis.

These results were adjusted for possible confounding factors, including comorbidities, positive surgical margins, and adjuvant hormone or radiation therapy given for up to 3 months after surgery.

Sprung and team used data from the Mayo Clinic prostatectomy database to identify all patients who underwent RRP for adenocarcinoma of the prostate between 1991 and 2005. After considering more than 10,000 patient records, a total of 3284 patients with a mean age of 61 years were included in the study. Of these, 1642 patients had GA with NA matched to 1642 patients who had GA alone on the basis of age, surgical year, pathologic stage, pathologic Gleason score, presence of positive lymph nodes, and preoperative prostate-specific antigen levels.

“[I]t is likely that with longer follow-up, our general anaesthesia group, with a higher rate of systemic progression, would eventually realize a higher rater of prostate cancer deaths,” the researchers speculate.

Given that these data are from a retrospective study, Jung and team acknowledge that the findings do not prove causality, and prospective, randomized trials will be needed to confirm or refute the findings.

“We are unable to attribute which component(s) of neuraxial anaesthesia improved oncological outcomes,” Sprung et al comment. “We hypothesize that a reduction in systemic opioids is an important potential component to improved outcome, but this assumption is speculative and other components may have played a role.”

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