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    Post-RT proctitis less likely in ACE inhibitor users

    Agents are also linked to faster resolution of proctitis in hypertensive patients

    High-grade proctitis after radical radiation therapy with neoadjuvant or adjuvant hormonal therapy is significantly less likely in patients taking angiotensin-converting-enzyme (ACE) inhibitors.

    Also see: Major decline in prostate Bx rates follows PSA publications

    In addition, ACE inhibitor use is associated with a reduced risk of radiation-induced proctitis, said Abduelmenem Alashkham, PhD, MSc, at the 2016 AUA annual meeting in San Diego. The findings were also published in the International Journal of Radiation Oncology • Biology • Physics (2016; 94:93-101).

    “Based on propensity-score matched analysis, our findings suggest that the use of ACE inhibitors during radical radiation therapy to the prostate is significantly associated with low-grade proctitis,” said Dr. Alashkham, clinical postgraduate medical researcher in the section of urology at University of Dundee School of Medicine, Dundee, Scotland.

    A number of studies have investigated the potential association between ACE inhibitors and radiation-induced injury in renal, brain, gastrointestinal tract, and pelvic cancer, but no study previously has explored their effects in men with prostate cancer treated with radical radiotherapy and neoadjuvant/adjuvant hormonal therapy.

    A propensity score analysis was conducted in 817 patients (mean age, 68.9 years) who underwent radical radiation therapy with neoadjuvant or adjuvant hormone therapy as primary management. Patients were stratified into three groups: hypertensive patients who took ACE inhibitors (n=183), nonhypertensive patients who were not taking ACE inhibitors (n=428), and hypertensive patients who were not taking ACE inhibitors (n=206).

    After propensity score matching, there were 102 hypertensive patients taking ACE inhibitors and 103 patients in the other two groups. There were 13 or 14 in each group with Gleason grade 2 to 6 cancer, 25 to 30 in each group with Gleason grade 7 (3+4), and 58 to 64 with Gleason grade 7 (4+3) to 10. Stage T3 comprised 50 to 56 patients in each group. More grade 0 cancer was seen in hypertensive patients who took ACE inhibitors (n=68) compared with nonhypertensive patients who were not taking ACE inhibitors (n=40) and hypertensive patients who were not taking ACE inhibitors (n=18).

    The primary outcome was the incidence, severity, and duration of all types of radiation-induced proctitis.

    Next: Lower proctitis grades with ACE inhibitors

    Wayne Kuznar
    Wayne Kuznar is a contributor to Urology Times.

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