Effect of statin use on biochemical outcome following radical prostatectomy

Abstract

Study Type – Prognosis (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Statin use may reduce the risk of developing prostate cancer. Studies also suggest that the protective effect of statins may be beneficial for prostate cancer patients following treatment. Statin users may also have lower PSA than non‐users. Our study agrees with the findings that statin users may have lower PSA than non‐users. Contrary to the findings that statins are protective in prostate cancer this study shows no benefit and possible worse biochemical outcome after radical prostatectomy. OBJECTIVE • To determine the relationship between statin use and biochemical recurrence (BCR) following radical prostatectomy (RP). PATIENTS AND METHODS • A retrospective analysis was performed on 3198 RP patients between 1990 and 2008. • Exclusion criteria were neo‐adjuvant or adjuvant therapy, follow‐up <2 years, and insufficient pathological or prostate‐specific antigen (PSA) data. • Statin use was determined from the patient’s record. Clinical and pathological variables were compared between statin users and non‐users. • Kaplan–Meier and multivariate Cox regression analyses were performed to determine the effect of statin use on BCR. RESULTS • A total of 1261 patients fit criteria for analysis. There were 281 (22%) statin users. Mean age was 60 years and median follow‐up was 36 months (mean 43 months). • Statin users had a lower median preoperative PSA (6.4) compared with non‐users (7.1) (P < 0.05). In all, 80% of statin users had a pathological Gleason sum ≥7 compared with 67% of non‐users (P < 0.05). • On multivariate analysis, statin use was an independent predictor of BCR (hazard ratio 1.54, P < 0.05). Statin users had a lower 5‐year BCR‐free survival compared with non‐users (75% vs 84%, P < 0.05). CONCLUSIONS • Statin users are at an increased risk for BCR following RP. This finding may be due to the reduction in preoperative PSA potentially delaying diagnosis and/or masking aggressive disease. • Further studies are necessary to elucidate the impact of statin medications following prostate cancer therapy.

Pathological Characteristics, Biochemical Recurrence and Functional Outcome in Radical Prostatectomy Patients on Statin Therapy

“…Only one study found a dose-dependent reduction of the biochemical recurrence risk [22], while three others reported that there was no statistically significant association [11,20,23]. Ritch et al [24] had similar findings as our series. They reported a statistically significant higher rate of >7 Gleason score and that statin use was an independent predictor of BCR (HR 1.54, p < 0.05).…”

Statin use not associated with improved outcomes in patients treated with brachytherapy for prostate cancer

“…In contrast, Ritch et al (21) conducted a similar retrospective analysis of 1261 patients treated with radical prostatectomy. Statin users represented 22% of the cohort.…”

Impact of statin use on biochemical recurrence in patients treated with radical prostatectomy

“…In contrast, Ritch et al detected an increased risk of BCR in PC patients using statins after RP. 16 In patients classified as D'Amico low-risk category, those taking statins had a significantly shorter BCR-free survival than patients not taking statins. In contrast, statin users in the intermediate and high-risk categories had no significant difference in BCR compared with non-users.…”

“…This is further supported by a significantly higher rate of patients with a pathological Gleason sum X7 in statin users compared with non-statin users in the study cohort. 16 In addition, another study showed a significantly lower PSA in patients using statins and Gleason sum X7. 12 However, it may be questioned if a PSA reduction is the explanation for the unfavorable outcome of statin users in the study because the rate of patients with a pathological Gleason sum X7 was also higher in the group of statin users in a study that found statin use to be associated with favorable outcome.…”

“…10 A total of seven studies investigated the association of statin use with BCR in PC patients treated with RP. Of these, five studies showed no association, [11][12][13][14][15] whereas in one study statin use was associated with increased 16 and in one study with decreased 17 risk of BCR.…”