The impact of NSAID use on PSA level and prostate cancer diagnosis

Over the years there have been several studies suggesting that regular use of non-steroidal anti-inflammatory agents (NSAIDs) — the most common being aspirin — can decrease prostate inflammation and prostate cancer risk. Since aspirin and other NSAIDs are commonly used to prevent cardiovascular disease, it will be apparent that there is going to be relatively high use of these agents in the men who are also at some degree of risk for prostate cancer.

Fowke et al. investigated the association between NSAID use, PSA level, prostate volume, and prostate cancer diagnosis. They started from the hypothesis that PSA levels and prostate volumes would be lower in men who were regular NSAID users, and they based their study on data from 1,277 men of > 40 years of age who participated in the Nashville Men’s Health Study and who were scheduled for prostate biopsy.

The key findings of Fowke and colleagues can be summarized as follows:

  • Roughly 46 percent of patients reported using NSAIDs, with the majority (37 percent) being aspirin users.
  • After adjusting for age, race, and other factors, average prostate volume was similar between aspirin users and non-users (47.6 vs 46.0 ml).
  • Average PSA levels were significantly lower in aspirin users (7.3 vs 8.0 ng/ml) than among other patients.
  • The association between PSA level and aspirin use was significant in men with “latent” prostate cancer (6.1 vs 7.3 ng/ml), marginal in patients with high-grade prostatic intraepithelial neoplasia (5.0 vs 5.9 ng/ml), and non-significant in men with a negative biopsy (5.6 vs 5.7 ng/ml).
  • The strongest association between PSA level and aspirin use was in men diagnosed with cancer and with a prostate volume ≥ 60 ml or more (7.3 vs 12.7 ng/ml); in other words, men with very large prostates who took aspirin but had prostate cancer had significantly lower PSA levels that men with prostates of the same size who did not take aspirin.

The authors conclude that — at least in this study — PSA levels were significantly lower in aspirin users diagnosed with latent prostate cancer, and that there was no association between NSAID use and prostate volume.

The authors then state that, “Results suggest that aspirin may affect prostate cancer detection, suggesting a potential detection bias to address in future studies of nonsteroidal anti-inflammatory drugs and prostate cancer prevention.”

However, an alternative interpretation of these data is that, in men with small to normal-sized prostates, regular aspirin use may have some degree of preventive impact on prostate cancer development, and that patients known to be taking aspirin should be monitored differently than patients who are not receiving NSAIDs. We clearly need more data from prospective studies to be able to understand what is actually going on in the prostate as a consequence of aspirin use to prevent cardiovascular disease.

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