Prostate cancer prognosis after initiation of androgen deprivation therapy among statin users. A population-based cohort study

Peltomaa, Antti I.; Raittinen, Paavo; Talala, Kirsi; Taari, Kimmo; Tammela, Teuvo L.J.; Auvinen, Anssi; Murtola, Teemu J.

doi:10.1038/s41391-021-00351-2

Cited by 26 publications

(45 citation statements)

References 23 publications

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“…In addition, studies that were not relevant to assessing the effects of statin use among PCa patients or had no extractable outcome data, as well as commentaries, conference abstracts, editorials, and reviews, were excluded. Finally, 12 studies met the inclusion criteria for the current meta-analysis [8,9,[23][24][25][26][27][28][29][30][31][32]. Six studies investigated the effects of statin use in PCa patients using ADT as their primary treatment [23][24][25][26][27][28].…”

Section: Literature Searchmentioning

confidence: 99%

“…Finally, 12 studies met the inclusion criteria for the current meta-analysis [8,9,[23][24][25][26][27][28][29][30][31][32]. Six studies investigated the effects of statin use in PCa patients using ADT as their primary treatment [23][24][25][26][27][28]. The other six studies investigated the effects of statin use in PCa patients using definitive therapy as their primary treatment [8,9,[29][30][31][32].…”

Section: Literature Searchmentioning

confidence: 99%

“…The percentage of statin users ranged from 26.3% to 61%. In total, five studies included patients initiating statin use after a PCa diagnosis [24][25][26][27][28], and one study (by Jung et al) included patients who initiated statin use before and after a PCa diagnosis [23]. Four studies reported both all-cause mortality and cancer-specific mortality [25][26][27][28], one only reported all-cause mortality [24], and one only reported cancer-specific mortality [23].…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

“…Five studies compared PCa-specific mortality in PCa patients receiving ADT as their primary treatment [23,[25][26][27][28]. One of the studies (by Peltomaa et al) separately reported statin use before and after ADT initiation [28]. Therefore, HRs with 95% CIs were pooled for the four other studies.…”

Section: Statin Use and Cancer-specific Mortalitymentioning

confidence: 99%

“…In the five studies comparing PCa-specific mortality in PCa patients receiving ADT as their primary treatment [23,[25][26][27][28], three of them reported the HRs of PCa-specific mortality for prevalent statin users (pre-ADT) [26][27][28]. The combined results showed that the pre-ADT use of statins was not significantly associated with a reduction in the risk of PCa-specific mortality (HR = 0.84, 95% CI = 0.62-1.13, p = 0.25, I 2 = 89%, Figure 3a).…”

Section: Statin Use and Cancer-specific Mortalitymentioning

confidence: 99%

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The Effects of Statins on Prostate Cancer Patients Receiving Androgen Deprivation Therapy or Definitive Therapy: A Systematic Review and Meta-Analysis

Hou

Shao

2022

Pharmaceuticals

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Mortality associated with statin use has been reported in prostate cancer (PCa) patients treated with androgen deprivation therapy (ADT) or definitive therapy in several observational studies, although the results have varied. This study aimed to analyze the association of statin use with all-cause mortality and cancer-specific mortality among PCa patients receiving ADT or definitive therapy as their primary treatment and to examine the effect of statin initiation (pre-ADT) timing on outcomes. A systematic literature search of PubMed, the Cochrane library, and Embase was conducted from database inception to 4 October 2021. In total, 12 eligible studies from 976 references were included in the final analysis. The results showed that statin use was associated with a significant reduction in the risks of all-cause mortality (hazard ratio (HR) = 0.73, 95% confidence interval (CI) = 0.64–0.84, p < 0.0001) and cancer-specific mortality (HR = 0.61, 95% CI = 0.49–0.77, p < 0.0001) in PCa patients receiving ADT. However, statin use before ADT initiation did not significantly lower the risk of all-cause mortality (HR = 0.87, 95% CI = 0.66–1.16, p = 0.35) or cancer-specific mortality (HR = 0.84, 95% CI = 0.62–1.13, p = 0.25) in advanced PCa patients receiving ADT. In contrast, statin use was not associated with a significantly reduced risk of all-cause mortality (HR = 0.69, 95% CI = 0.39–1.21, p = 0.20), but it was associated with a reduced risk of cancer-specific mortality (HR = 0.82, 95% CI = 0.68–0.98, p = 0.03) in PCa patients receiving definitive therapy. This review indicated that statin use in combination with ADT was correlated with better all-cause and cancer-specific mortality in PCa patients. However, the beneficial effect might not come from statin use before ADT initiation. In addition, statin use in combination with definitive therapy was correlated with a reduced risk of cancer-specific mortality in PCa patients. In the future, randomized controlled trials are needed to validate the efficacy of statin use in combination with primary treatment for PCa among PCa patients.

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Section: Literature Searchmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Section: Statin Use and Cancer-specific Mortalitymentioning

confidence: 99%

Section: Statin Use and Cancer-specific Mortalitymentioning

confidence: 99%

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The Effects of Statins on Prostate Cancer Patients Receiving Androgen Deprivation Therapy or Definitive Therapy: A Systematic Review and Meta-Analysis

Hou

Shao

2022

Pharmaceuticals

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Statin Use and Survival Among Men Receiving Androgen-Ablative Therapies for Advanced Prostate Cancer

et al. 2022

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ImportanceEpidemiological evidence supports a role for statins in improving survival in advanced prostate cancer, particularly among men receiving androgen-ablative therapies.ObjectiveTo study the association between statin use and survival among men with prostate cancer receiving androgen deprivation therapy (ADT) or androgen receptor axis–targeted therapies (ARATs).Data SourcesThis systemic review and meta-analysis used sources from MEDLINE, EMBASE, Epub Ahead of Print, Cochrane Clinical Trials, Cochrane Systematic Reviews, and Web of Science from inception to September 6, 2022.Study SelectionObservational studies reporting associations of concurrent statin use and survival outcomes (in hazard ratios [HRs]).Data Extraction and SynthesisTwo authors independently abstracted all data. Summary estimates pooled multivariable HRs with 95% CIs using the generic inverse variance method with random-effects modeling. A priori specified subgroup and sensitivity analyses were undertaken, and heterogeneity, study quality, and publication bias were evaluated. Confidence in the evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.Main Outcomes and MeasuresOverall mortality and prostate cancer–specific mortality (PCSM).ResultsTwenty-five cohorts of 119 878 men (65 488 statin users [55%]) with more than 74 416 deaths were included. Concurrent statin use was associated with a 27% reduction in the risk of overall mortality (HR, 0.73 [95% CI, 0.66-0.82]; I2 = 83%) and a 35% reduction in the risk of PCSM (HR, 0.65 [95% CI, 0.58-0.73]; I2 = 74%), with substantial heterogeneity in both estimates. Subgroup analyses identified a PCSM advantage associated with statins for men receiving ARATs compared with ADT alone (HR, 0.40 [95% CI, 0.30-0.55] vs 0.68 [95% CI, 0.60-0.76]; P = .002 for difference). Confidence in the evidence was rated low for both outcomes.Conclusions and RelevanceThe findings of this meta-analysis show that concurrent statin use was associated with reduced overall mortality and PCSM among men receiving androgen-ablative therapies for advanced prostate cancer. These findings are limited by the observational nature of the data and residual unexplained interstudy heterogeneity. Randomized clinical trials are warranted to validate these results.

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Statin use and mortality risk in Asian patients with prostate cancer receiving androgen deprivation therapy: A population‐based cohort study

Lee,

Chan,

Hui

et al. 2023

Cancer Medicine

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BackgroundThis study aimed to examine the associations between the use of statins concurrent with androgen deprivation therapy (ADT) and the risks of mortality in Asian patients diagnosed with prostate cancer (PCa).MethodsAdult patients (≥18 years old) diagnosed with PCa who were receiving any form of ADT and were being treated at public hospitals in Hong Kong from December 1999 to March 2021 were retrospectively identified, with follow‐up conducted until September 2021. Patients who had received medical castration for <180 days without subsequent bilateral orchidectomy, those who had used statins concurrently with ADT for <180 days, and those with missing baseline total cholesterol levels were excluded. Statin users were defined as individuals who had used statins for ≥180 days concurrent with ADT, while non‐users were those who had not used any statins. PCa‐related mortality was the primary outcome, while all‐cause mortality served as the secondary outcome. Inverse probability treatment weighting was employed to balance the covariates.ResultsA total of 4920 patients were included, consisting of 2578 statin users and 2342 non‐users (mean age 76.1 ± 8.2 years). Over a mean follow‐up period of 4.2 ± 3.3 years, it was observed that statin users had significantly lower risks of both PCa‐related mortality (weighted hazard ratio [wHR] 0.56 [95% confidence interval (CI) 0.48, 0.65], p < 0.001) and all‐cause mortality (wHR 0.57 [95% CI 0.51, 0.63], p < 0.001), regardless of the type of ADT used. Notably, these associations were more pronounced among patients with less advanced PCa, as indicated by the absence of androgen receptor antagonist or chemotherapy usage (p value for interaction <0.001 for both outcomes).Conclusion(s)The use of statins concurrent with ADT was associated with reduced mortality risks among Asian patients with PCa. These findings suggest the need for additional research to explore the potential role of statins in the treatment of PCa patients.

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Prostate cancer prognosis after initiation of androgen deprivation therapy among statin users. A population-based cohort study

Cited by 26 publications

References 23 publications

The Effects of Statins on Prostate Cancer Patients Receiving Androgen Deprivation Therapy or Definitive Therapy: A Systematic Review and Meta-Analysis

The Effects of Statins on Prostate Cancer Patients Receiving Androgen Deprivation Therapy or Definitive Therapy: A Systematic Review and Meta-Analysis

Statin Use and Survival Among Men Receiving Androgen-Ablative Therapies for Advanced Prostate Cancer

Statin use and mortality risk in Asian patients with prostate cancer receiving androgen deprivation therapy: A population‐based cohort study

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