Statins and prostate cancer: what’s the deal?


Yet again there is a lot of media noise about the possible impact of statins — drugs like simvastatin and Lipitor (atorvastatin) — on risk for prostate cancer. This time it results from a 15-year follow-up study of men at the Durham VA Medical Center in North Carolina.

According to media reports, this study showed that men who took a statin had significantly lower PSA levels than men who didn’t. The men taking statins had PSA levels that were 4 percent lower than those who didn’t. [The actual abstract of the paper by Hamilton et al. is now available for review on line. It was not available at the time the original commentary was written.]

Just so that we can be completely clear … These men did not have prostate cancer. So we have to assume that their PSA was likely to be in the 0.5 to 5.0 ng/ml range. Let’s be generous and make the assumption that the mean PSA level of men NOT taking a statin was 5.0 ng/ml. In that case, the mean PSA level of the men who WERE taking a statin would have been 5.0 less 4 percent = 4.8 ng/ml!

Now I don’t mean to be a cynic. I understand that this number may be statistically significant, but that isn’t the question that needs to be addressed. The question that must be addressed is, “Is this clinically significant?” In 20 years of reading the prostate cancer literature, I don’t ever remember seeing or hearing anyone suggest that there was a clinically significant distinction between a man with a PSA of 4.8 ng/ml and a man with a PSA of 5.0 ng/ml.

Millions of men of my age (I was 60 this year) take statins, including me. If they help to prevent prostate cancer, great. However, I am hard-pressed to believe that a reduction of my PSA level by 4 percent is likely to have any meaningful impact on my real risk for clinically significant prostate cancer. While I don’t intend to stop taking statins over it, I certainly wouldn’t dream of starting to take them on the basis of this evidence!

If statins are ever to have a meaningful role in the prevention and management of prostate cancer, we are going to need to see evidence that is way more compelling that this!

4 Responses

  1. I have been taking a statin med for about two years and have seen a significant drop in my PSA factor. Is there a possibility that this could “mask” an issue in the prostate?
    LGB

  2. Dear Mr. Barbaree: A possibility — Yes. A likelihood, however, would depend on all sorts of other factors such as your age, your family history, what your PSA was before you started taking the statin, how much the PSA level has fallen, any other changes in your diet, exercise regimen, etc., etc.

    The single most important factor here is that you make sure that your doctors are aware of when you started taking the statin and the subsequent effect on your PSA.

  3. After reading this I’m left with the question: How do the lower PSA rates correlate with PCa development or growth?

    If statins are having a positive effect, isn’t this as or more important than a reduction in biopsy rates, and at the low PSA numbers used, won’t the majority of the cancers that would be missed be clinically insignificant?

  4. […] Posted on November 17, 2008 by E. Michael D. (“Mike”) Scott On October 31st we reported that statins lower PSA levels. Now comes evidence that aspirin and other NSAIDs also lower PSA levels, in both patients with […]

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