Statin Medications Are Associated With a Lower Probability of Having an Abnormal Screening Prostate-specific Antigen Result

Shi, Ying; Fung, Kathy Z.; Freedland, Stephen J.; Hoffman, Richard M.; Tang, Victoria; Walter, Louise C.

doi:10.1016/j.urology.2014.06.069

Cited by 10 publications

(5 citation statements)

References 28 publications

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“…Statin use was associated with a reduced probability of having an abnormal screening PSA result for each of the commonly-used PSA thresholds of >2.5 ng/ml, >4.0 ng/ml and >6.5 ng/ml (REF. 96). Another study examined the effect of use of statins, thiazide diuretics and nonsteroidal anti-inflammatory drugs on PSA levels in a cohort of 1,864 men ≥40 years of age from the National Health and Nutrition Examination Survey that had no history of prostate cancer, prostatitis or recent prostate manipulations.…”

Section: Statin Use and Psa Levelsmentioning

confidence: 99%

The current evidence on statin use and prostate cancer prevention: are we there yet?

et al. 2016

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An increasing amount of data supports an inverse association between statin use and cancer risk. The findings for prostate cancer, particularly advanced disease, are the most promising of all cancers studied. Use of these agents seems to also be associated with improved prostate-cancer-specific survival, particularly in men undergoing radiotherapy, suggesting usefulness of statins in secondary and tertiary prevention. Some study results might be influenced by increased PSA screening and health-conscious behaviour in statin users but these factors are unlikely to completely account for observed beneficial effects. The epidemiological evidence is supported by preclinical studies that show that statins directly inhibit prostate cancer development and progression in cell-based and animal-based models. The antineoplastic effect of statins might arise from a number of cholesterol-mediated and non-cholesterol-mediated mechanisms that affect pathways essential for cancer formation and progression. Understanding these mechanisms is instrumental in drug discovery research for the development of future prostate cancer therapeutics, as well as in designing clinical trials to test a role for statins in prostate cancer prevention. Currently, sufficient data are lacking to support the use of statins for the primary prevention of prostate cancer and further research is clearly warranted. Secondary and tertiary prevention trials in men who have been diagnosed with prostate cancer might soon be performed.

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Section: Statin Use and Psa Levelsmentioning

confidence: 99%

The current evidence on statin use and prostate cancer prevention: are we there yet?

et al. 2016

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“…A search of the Pubmed database did not find any prior studies reporting a similar effect. However, the same search revealed recent studies [ 28 – 31 ] which reported that men who used many commonly prescribed medicines had significantly reduced PSA levels. Examples of medicines which were associated with lower PSA level are: aspirin (−4%,−45%), statins (−4.6%,−13%), metformin (−14%), insulin (−16%), NSAIDs (−6%), and thiazide diuretics (−26%).…”

Section: Discussionmentioning

confidence: 96%

Patient Specific Characteristics Are an Important Factor That Determines the Risk of Acute Grade ≥ 2 Rectal Toxicity in Patients Treated for Prostate Cancer with IMRT and Daily Image Guidance Based on Implanted Gold Markers

Liu

et al. 2016

OMICS J Radiolc

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AimTo model acute rectal toxicity in Intensity Modulated Radiation Therapy (IMRT) for prostate cancer using dosimetry and patient specific characteristics.MethodsA database of 79 prostate cancer patients treated with image guided IMRT was used to fit parameters of Lyman-Kutcher-Burman (LKB) and logistic regression Normal Tissue Complications Probability (NTCP) models to acute grade ≥ 2 rectal toxicities. We used a univariate regression model to find the dosimetric index which was most correlated with toxicity and a multivariate logistic regression model with machine learning algorithm to integrate dosimetry with patient specific characteristics. We used Receiver Operating Characteristics (ROC) analysis and the area under the ROC curve (AUC) to quantify the predictive power of models.ResultsSixteen patients (20.3%) developed acute grade≥2 rectal toxicity. Our best estimate (95% confidence interval) of LKB model parameters for acute rectal toxicity are exponent n=0.13 (0.1–0.16), slope m=0.09 (0.08–0.11), and threshold dose TD50=56.8 (53.7–59.9) Gy. The best dosimetric indices in the univariate logistic regression NTCP model were D25% and V50Gy. The best AUC of dosimetry only modeling was 0.67 (0.54, 0.8). In the multivariate logistic regression two patient specific variables were particularly strongly correlated with acute rectal toxicity, the use of statin drugs and PSA level prior to IMRT, while two additional variables, age and diabetes were weakly correlated. The AUC of the logistic regression NTCP model improved to 0.88 (0.8, 0.96) when patient specific characteristics were included. In a group of 79 patients, 40 took Statins and 39 did not. Among patients who took statins, (4/40)=10% developed acute grade ≥2 rectal toxicity, compared to (12/39)=30.8% who did not take statins (p=0.03). The average and standard deviation of PSA distribution for patients with acute rectal toxicity was PSAtox = 5.77 ± 2.27 and it was PSAnotox = 9.5 ± 7.8 for the remainder (p=0.01).ConclusionsPatient specific characteristics strongly influence the likelihood of acute grade ≥ 2 rectal toxicity in radiation therapy for prostate cancer.

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“…23 Statin users had a lower median PSA level in our study, concordant with some previous studies. 24 One possible mechanism is hemodilution of PSA in men with overweight or obesity. 25,26 People with dyslipidemia are 60% to 70% more likely to be obese.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins

et al. 2022

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IMPORTANCE Prostate-specific antigen (PSA) screening for prostate cancer has resulted in a slight reduction in prostate cancer mortality but also a concomitant overdiagnosis of low-risk tumors. Prostate-specific antigen levels are affected by use of cholesterol-lowering statin drugs, but the association of statin use with PSA screening performance is unknown. OBJECTIVETo investigate whether statin use was associated with outcomes of a randomized PSA-based prostate cancer screening intervention. DESIGN, SETTING, AND PARTICIPANTS This post hoc subgroup analysis of a cohort from a population-based randomized clinical trial used data from the population-based Finnish Randomized Study of Prostate Cancer Screening, which randomized men to PSA screening or routine care from March 1, 1996, to December 31, 1999, with follow-up continuing until December 31, 2015. The population included all men aged 55 to 67 years at baseline and residing in the Tampere or Helsinki districts of Finland. Information on statin purchases from 1996 to 2009 was obtained from a national prescription registry. Eligible men were identified from the population registry of Finland. Prevalent prostate cancer cases at baseline were excluded. Data were analyzed from January 1, 2019 to March 31, 2021. INTERVENTIONS Three invitations for PSA screening at 4-year intervals from 1996 to 2007 vs routine care.MAIN OUTCOMES AND MEASURES Risk for prostate cancer overall, high-risk disease, and prostate cancer mortality in the screening group vs the control group as an intention-to-treat analysis. The analysis was stratified by statin use. RESULTSThe study comprised 78 606 men (median age, 59 years [range, 55-67 years]) with statin purchase data available. Although PSA screening was associated with increased prostate cancer incidence among statin nonusers (screening vs control, 11.2 vs 8.6 per 1000 person-years); rate ratio [RR], 1.31; 95% CI, 1.24-1.38), no similar increase in incidence was observed among statin users (6.9 vs 5.9 per 1000 person-years; RR, 1.02; 95% CI, 0.95-1.10; P < .001 for interaction). Incidence of low-risk (Gleason score 6) and localized tumors was lower among statin users, whereas detection of tumors with a Gleason score of 8 to 10 was similar. Screening was associated with a lower incidence of metastatic tumors regardless of statin use. CONCLUSION AND RELEVANCEIn this post hoc subgroup analysis of a cohort from a population-based randomized clinical trial, PSA screening among statin users was associated with a decreased incidence of advanced prostate cancer that was similar among statin nonusers, but with less increase in detection of low-grade localized tumors in statin users than in nonusers. These findings suggest that statin use does not materially compromise benefits of PSA-based screening.

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Statin Medications Are Associated With a Lower Probability of Having an Abnormal Screening Prostate-specific Antigen Result

Cited by 10 publications

References 28 publications

The current evidence on statin use and prostate cancer prevention: are we there yet?

The current evidence on statin use and prostate cancer prevention: are we there yet?

Patient Specific Characteristics Are an Important Factor That Determines the Risk of Acute Grade ≥ 2 Rectal Toxicity in Patients Treated for Prostate Cancer with IMRT and Daily Image Guidance Based on Implanted Gold Markers

Outcomes of Screening for Prostate Cancer Among Men Who Use Statins

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