How Painkillers Could Impact Prostate Cancer

Prostate cancer surgery anesthesia supplemented with painkiller lowered recurrence risk

(RxWiki News) One method of treating prostate cancer involves removing the entire prostate gland. The types of medications given during this surgery, a new study has found, may influence the course of the disease.

Researchers have discovered that men who received a painkiller before surgery, along with general anesthesia during prostate cancer surgery, were less likely to see their cancer return than men who received general anesthesia only.

Painkillers given during and after surgery, the researchers theorized, may limit the immune system’s ability to fight off the cancer cells.

"Find out what type of anesthesia you’ll be given during surgery."

Juraj Sprung, MD, PhD, a Mayo Clinic anesthesiologist, and colleagues used Mayo Clinic databases and medical records to identify men who underwent a radical prostatectomy (surgical removal of prostate) between 1991 and 2005.

The goal of this study was to compare the long-term outcomes of men who received: 1) only general anesthesia, used to make the patient unconscious during surgery, or 2) general anesthesia along with what physicians call “neuraxial anesthesia,” which deadens pain in a particular area of the body.

Dr. Sprung and team explained that the general anesthesia, the surgery itself and opioids (strong painkillers) typically used after the surgery all put a strain on the body’s immune system. These stresses can reduce the immune system’s ability to attack and kill any cancer cells that are released when the tumor is manipulated and removed during surgery.

Spinal (injected into the spinal cord) or epidural (injected into a fluid sack in the spine) painkillers given before the operation reduce the need for opioids after surgery, the researchers said.

For this study, the research team identified 1,642 men who had received general anesthesia along with neuraxial analgesia. These participants were matched with 1,642 men who received general anesthesia only.

These researchers estimated 10-year outcomes for both groups and discovered the following:

  • The prostate cancer progressed in 3.2 percent of men who received general anesthesia only and 1.3 percent of men who received general and neuraxial anesthesia.
  • Cancer recurred in 22.8 percent of the men who received general anesthesia only and 20.8 percent of men who received two forms of anesthesia.
  • Prostate cancer-specific deaths occurred in 1.4 percent of men who received general anesthesia only and 0.4 percent of those who received general and neuraxial anesthesia.
  • 9.5 percent of men in the general anesthesia group died from causes other than cancer, compared to 7.8 percent of men in the general and neuraxial anesthesia group.

“Supplementing general anesthesia with neuraxial analgesia for prostate oncologic surgery was associated with decreased systemic cancer progression and improved overall survival when compared with general anesthesia only,” the researchers wrote.

Dr. Sprung said in a statement, “Provided future studies confirm what we’ve found in this study, maybe down the line this would be a standard of care for pain management in patients undergoing cancer surgery.”

This study was published in the December issue of the British Journal of Anesthesiology.

The Center for Translational Science Activities supported this research. No conflicts of interest were declared.

Review Date: 
December 19, 2013