Of statins, NSAIDs, and “all-cause” mortality in prostate cancer patients


There have been a lot of data published on the potential implications of long-term use of statins (e.g., simvastatin/Zocor and atorvastatin/Lipitor) and non-steroidal antianflammmatory drugs (NSAIDs, e.g.,  aspirin and ibuprofen) in prevention and management of prostate cancer. But what we are really sure of at the moment is limited.

A recent paper by Katz et al. exemplifies the current state of what we do and don’t know.

The authors studied the use of  NSAIDs and statins by 7,042 men who had been treated for localized prostate cancer between 1990 and 2003. These 7,000+ men all had data recorded in the CaPSURE database and comprised 4,611 radical prostatectomy (RP) and 2,431 radiotherapy (RT) patients.

By comparing patients’ clinical and sociodemographic characteristics, grouping them according to statin and NSAID use, and examining associations between medication use, comorbid illnesses, and “all-cause” mortality (ACM), Katz et al. were able to show that:

  • Median follow-up post-treatment was 4 (0-16) years (range, 0 to 16 years).
  • For the RP patients:
    • “Ever-use” (i.e., continuous, long-term use) of a statin was associated with a lower risk of ACM than for non-statin users (hazard ratio [HR] = 0.35).
    • “Ever-use” of an NSAID was also associated with a lower risk of ACM than for non-NSAID users (HR = 0.47).
  • For the RT patients:
    • “Ever-use” of a statin was associated with a lower risk of ACM than for non-statin users (HR = 0.59)
    • “Ever-use” of an NSAID was also associated with a lower risk of ACM than  for non-NSAID users (HR = 0.39).

The authors conclude that, “In a population of men with prostate cancer, statin and NSAID ever-use were associated with a reduced risk of ACM.”

In a follow-up commentary in “Beyond the Abstract” on the UroToday web site, two of the authors (Katz and D’Amico) add some additional and important remarks about this study.

First of all, they point out that the findings described above do not, necessarily, suggest a true causal relationship between the “ever-use” of statins and NSAIDs and a reduction in ACM. They only show an association between these two factors. So, for example, what the data may really be showing is that “ever-use” of a statin or an NSAID reduces the risk for non-prostate cancer-specific mortality (non-PCSM) among prostate cancer patients. This would suggest that a reduction in ACM would be linked to an increased risk for PCSM among prostate cancer patients taking statins or NSAIDs. We will need more long-term data to confirm or deny this hypothesis.

Second, they note that, based on these data, specialists may need to look seriously at treatment recommendations for prostate cancer patients that incorporate strategies to reduce ACM. If commonly used drugs like statins and NSAIDs really do affect non-PCSM in men treated for prostate cancer, then specialists should be looking much more carefully at management of other potential co-morbidities and not just prognistic factors that are primarily associated with risk for PCSM. This would suggest the need for a greater degree of communication between a patient’s primary prostate cancer specialist and his primary care physician. The “New” Prostate Cancer InfoLink can’t help but think that this would be a good thing — from the very first day of a patient’s diagnosis!

3 Responses

  1. PCSM = Prostate Cancer Specific Mortality ?

    Please more: “communication between a patient’s primary prostate cancer specialist and his primary care physician,” that has to be a good thing.

    Seems like there should be a comparison of ACM for statins and NSAIDs for a control group of patients who were not diagnosed with prostate cancer as well. If these drugs improve life expectancy for both non-prostate cancer and prostate cancer patients, doesn’t that imply that the therapeutic benefit of the drugs is unrelated to prostate cancer?

  2. Dear Dave:

    1. Yes, PCSM = prostate cancer-specific mortality.

    2. The question whether we should test the effect of statins to prevent prostate cancer has been discussed for a while. The problem is that it would need another trial as large as the original Prostate Cancer Prevention Trial (i.e., 18,000 or more patients), and it is unlikely that anyone would be willing to “foot the bill” today. It is even less likely that we will ever see a trial in which men with and without prostate cancer are randomized to treatment with or without a statin or an NSAID because it would probably be unethical to give either of these two types of drugs to a man who didn’t actually need them. Statins and NSAIDs do both have other side effects.

    3. You are correct. The whole point of this article is that any apparent therapeutic benefit of these drugs may well be unrelated to prostate cancer and that any effect they are having is more probably related to their ability to lower risk of other causes of death for a while.

  3. The whole point of this article is that any apparent therapeutic benefit of these drugs may well be unrelated to prostate cancer and that any effect they are having is more probably related to their ability to lower risk of other causes of death for a while.

    Isn’t it ironic that, if you lower the risk of other causes of death, you increase the risk of death from prostate cancer.

    That thought came to me some years back when I started improving my life-style with a view to fighting my prostate cancer diagnosis. I realised that in doing this I might be actually reducing my risk of heart failure — the major threat to any man in Western societies — and therefore by default increasing the probability of a prostate cancer-specific death.

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