It has been known for a while that statins and nonsteroidal anti-inflammatory drugs (NSAIDs) can affect PSA levels. A new paper now opens the question of whether men who take these and/or other drugs for significant time periods are at risk for a “missed” diagnosis of prostate cancer.
Chang et al.analyzed data from men of 40 or more years of age who did not have prostate cancer from the 2003 to 2004 and 2005 to 2006 cycles of the National Health and Nutrition Examination Survey (NHANES). They excluded all men with recent prostate manipulation, prostatitis, and those on hormone therapy. Their goal was to identify effects on PSA levels associated with short- and long-term use of the 10 most commonly prescribed classes of medication.
The results of their study showed that:
- 1,864 men met the inclusion criteria for their analysis.
- Regular use of NSAIDs, statins, and thiazide diuretics was inversely related to PSA levels.
- Use of an NSAID, a statin, or a thiazide diuretic for a period of 5 years was associated with reduction in PSA levels by 6, 13, and 26 percent, respectively.
- Use of statins together with thiazide diuretics showed the greatest reduction in PSA levels: 36 percent after 5 years.
- Concurrent use of a calcium channel blocker minimizes or negates the inverse relationship of statin use and PSA level.
The authors conclude that use of NSAIDs, statins, and thiazide diuretics can reduce PSA levels by clinically relevant amounts — but that the impact of regularly consuming these common medications on individual test results for risk of prostate cancer is unknown.
An article on the HealthDay web site also addresses these data. It is clear that these types of drug are very commonly being used by men > 50 years of age who are at elevated risk for prostate cancer, but it is not clear (yet) how to interpret PSA data in such men.
Filed under: Diagnosis, Risk Tagged: | diuretic, NSAID, PSA, risk, statin
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Since an elevated PSA is not cancer specific, what is the significance of the study? Reducing inflammation and promoting better urinary flow would be considered good things for prostate health and better quality of life. I find that their final conclusion is the most valid part of the study …
Although I am profoundly ignorant on matters relating to prostate cancer compared to Messrs. Valle and Scott, I wonder whether there is a potential “prostate cancer detection” problem with medications that — despite benefits they offer — tend to reduce PSA levels by an amount that cannot be determined and/or that varies from one patient to the next. The patient has a PSA that is below some (perhaps artificial) “biopsy threshold” — or sees his PSA going down rather than up — and does not get a biopsy (or not until it is too late). And the doctor cannot “adjust” for the effect of that other medication because the magnitude of the reduction is unknown and impossible to determine for any particular patient (or because the doctor has no idea that there could be any impact!).
I have read criticism of finasteride or dutasteride for chemoprevention on this basis — for example Dr. Walsh’s observation that finasteride does not prevent prostate cancer but instead only prevents people from knowing that they have it. If that is true for a drug that reduces PSA levels in a relatively predictable (though I suspect not entirely predictable) way — so that it can be taken into account by the doctor or patient in evaluating PSA levels and trends — then it may be more so for a drug that probably reduces PSA levels, but by an amount that cannot easily be determined. Of course, there are people who need these drugs — e.g., statins — for reasons that have nothing to do with their prostates. But, purely from a prostate cancer perspective, I wonder whether they might do more harm than good.
One related point — I have seen studies that show reduced rates of prostate cancer among those who take statins. But I have always wondered — is it the statin, or the low cholesterol that does this? Has there been a study comparing those who have low total and LDL cholesterol levels through use of statins to those who achieve the same levels without statins?
In the immortal words of the great sage Confucius: “Life is really simple, but we insist on making it complicated.”