beta adrenergic receptor blockade as a novel therapy for patients with adenocarcinoma of the prostate

Conditions: Prostate Cancer

Summary: this will be a single arm, window of opportunity study in men with treatment-naïve prostate cancer who will proceed to prostatectomy. men will be treated with carvedilol prior to undergoing prostatectomy.

preclinical research has demonstrated that autonomic nerve fibers in the prostate gland regulate prostate cancer development and dissemination. studies in human prostate cancer specimens indicate that higher densities of autonomic nerve fibers are associated with poor clinical outcomes. in this clinical trial the beta-blocker carvedilol will be given to men diagnosed with prostate cancer. men will begin carvedilol following their diagnostic prostate biopsy and will continue carvedilol until prostatectomy. the primary outcome measure is the change in ki-67 and tunel assay biomarkers in prostate biopsy and prostatectomy tissues.

Eligibility criteria:
inclusion criteria: 1. the patient must be able to provide study-specific informed consent prior to study entry. 2. age ≥ 18 3. ecog performance status 0-1 4. pathologically proven diagnosis of prostate adenocarcinoma diagnosed by prostate biopsy with archival biopsy tissue available for analysis. the amount of cancer tissue present must be sufficient for analysis. 5. prostate adenocarcinoma classified as intermediate or high-risk as defined by one or more of the following criteria: psa \>10 ng/ml, gleason score ≥7, or tumor stage ≥t2b 6. patients must have no evidence of metastatic disease (including clinically negative pelvic lymph nodes) as established by imaging (ct or mri of the pelvis and a bone scan) within 60 days prior to registration. equivocal bone scan findings are allowed if plain film x-rays are negative for metastasis. 7. the patient and the attending urologist have decided to proceed with prostatectomy 8. lab values meeting the following criteria 1. total bilirubin \< 2.0 x upper limit of normal (uln) 2. aspartate aminotransferase (ast) ≤ 2.5 x uln. 3. alanine aminotransferase (alt ) ≤ 2.5 x uln 4. absolute neutrophil count (anc) \> 1.5 k/mm3 5. platelets \> 100 k/mm3 6. hemoglobin ≥9.0 g/dl 7. calculated creatinine clearance ≥ 40 ml/min exclusion criteria: 9. patients with low risk prostate adenocarcinoma as defined by meeting all three of the following criteria: gleason score ≤6, psa \<10 and tumor stage ≤t2b 10. the presence of metastatic disease including to pelvic lymph nodes 11. use of any beta-blocker at the time of diagnostic biopsy for prostate cancer or use of any beta-blocker at the time of screening. if the investigator does not believe that carvedilol can be safely added to the patients existing antihypertensive regimen, then the patient is not eligible for this study. 12. prior therapy for prostate cancer including radiation therapy (external beam or brachytherapy), surgery, high-intensity focused ultrasound (hifu), cryotherapy, previous hormonal therapy with androgen deprivation therapy by bilateral orchiectomy or lhrh analogues (e.g. leuprolide, goserelin, triptorelin, degarelix), antiandrogens, ketoconazole, abiraterone or chemotherapy (for prostate cancer, chemotherapy in the past for other indications is allowed). 13. treatment with any investigational agent within 30 days prior to being registered for protocol therapy. 14. no prior malignancy is allowed except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, or other cancer for which the patient has been disease-free for at least 5 years. 15. inability to take oral medication 16. hypotension (systolic blood pressure \<100 mm hg or diastolic blood pressure \<50 mm hg) or bradycardia (pulse \<55 beats/min) at screening. for patients with a functioning pacemaker, bradycardia is not an exclusion. 17. bronchial asthma or related bronchospastic conditions such as chronic obstructive pulmonary disease. 18. patients must not have new york heart association class iii or iv heart failure at the time of screening. patients must not have any unstable angina, myocardial infarction, or serious uncontrolled cardiac arrhythmia within 6 months prior to registration. 19. prolonged qtc interval on pre-entry 12-lead ecg (\> 460 msec), obtained within 28 days prior to being registered on study. no second- or third-degree atrioventricular block on screening 12-lead ecg. 20. any other serious illness or medical condition that the principal investigator feels would make the patient a poor candidate for this study

Keywords: carvedilol biomarkers autonomic nerves