PPIs Linked With Higher Rate of Post-RP Complications

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Over the past 20 years, use of proton pump inhibitors has more than doubled, particularly among older adults.
Over the past 20 years, use of proton pump inhibitors has more than doubled, particularly among older adults.

SAN DIEGO—Over the past 20 years, use of proton pump inhibitors (PPI) has more than doubled, particularly among older adults. Recent studies link the reflux medications to a variety of adverse outcomes. Now new research presented at the American Urological Association's 2016 annual meeting associates PPIs with a higher rate of complications following radical prostatectomy (RP).

For the study, Mary E. Westerman, MD, and colleagues from Mayo Clinic in Rochester, MN, identified 9,338 prostate cancer (PCa) patients who underwent RP at their institution during 2001–2012. Of these, 372 (4%) were taking a PPI within 90 days of their surgery. Men taking a PPI were older (age 63 vs 61.5 years), had a higher body mass index (average 29.2 vs 28.2 kg/m2), and were more likely to have a Charlson Comorbidity Index of 3 or more (12.4% vs 5.6%) at the time of RP. 


With regard to PCa characteristics, men taking a PPI were significantly more likely to have cancers with a Gleason score of 7 or greater on biopsy (49.3% vs 39.8%) and at the time of RP (62.5% vs 51.1%). Post-RP results further revealed that PPI use was associated with a higher rate of positive surgical margins (21.6% vs 17.6%), pT3/T4 disease (20.5% vs 16.2%), and a higher rate of overall complications (29.4% vs 21.6%).

The investigators also looked at functional outcomes and found no difference in rates of erectile dysfunction or incontinence between the groups at 1 year.  Ten-year survival outcomes also did not differ significantly.  During a median follow up of 7.3 years, 81 men (0.9%) died from PCa.

The researchers found that PPI use was independently associated with a higher overall complication rate, after adjusting for relevant clinicopathologic variables. Medication usage may be a surrogate for worse health, or PPIs may influence post-surgical complications.

“Men taking PPIs were older with more comorbidities and pathologically more advanced disease,” Dr Westerman told Renal & Urology News. “PPI use may be associated with medical frailty that is incompletely adjusted for in our model.”

Dr Westerman believes further research is warranted into possible physiologic changes induced by PPIs that predispose patients to complications.

RELATED: Long-Term Radical Prostatectomy Outcomes Better for cT1a Prostate Cancer

“In the meantime, this finding may be used for patient counseling and risk stratification in both the pre- and postoperative settings,” Dr Westerman said. “For example, these patients may benefit from a thorough medical evaluation prior to surgery. Postoperatively, providers should maintain a higher index of suspicion for complications particularly if patients call with concerns. They may potentially even benefit from early post-operative follow-up, either with their surgeon or primary care provider to identify potential complications sooner.”

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