Prostate cancer patients on statins have better outcomes after radiotherapy

There is an increasing range of evidence to suggest that men who are on long-term statin therapy (with drugs like simvastatin, atorvastatin/Lipitor, or rosuvastatin/Crestor) are at lower risk for prostate cancer and do better than average in terms of treatment outcome if they are diagnosed with prostate cancer.

We should be clear immediately that we know of absolutely no data from prospective, randomized, double-blind clinical trials that support this clinical perception (yet). Nor are we aware of any trial currently being carried out to address this issue. However, data from retrospective analysis of  case series continues to support this perception.

Gutt et al. have just reported results from a retrospective analysis of data on 691 prostate cancer patients treated with radiation therapy between 1988 and 2006. Of these 691 patients, 189 (27 percent) were using statins, either during initial consultation or during follow-up.

According to their analysis, the research team reports that:

  • Median follow-up was 50 months after therapy.
  • Statin use was associated with a statistically significant improvement in 
    • Freedom from biochemical failure (P < 0.001)
    • Freedom from salvage androgen deprivation therapy (P = 0.0011)
    • Biochemical relapse-free survival (P < 0.001).
  • Improvement in freedom from biochemical failure among statin users was statistically significant for patients in low-, intermediate-, and high-risk groups.
  • Improvement in freedom from biochemical failure among statin users was independent of the use of ADT or radiation dose.
  • A pretreatment total cholesterol level < 187 and a low-density lipoprotein level < 110 were associated with improved 4-year freedom from biochemical failure.

Despite the lack of data from randomized controlled clinical trials, we appear to be reaching a point at which knowledge of the patient’s cholesterol level pretreatment, and statin therapy for patients with elevated cholesterol levels, may be a definitive issue for prostate cancer therapy and quality of long-term outcomes.

6 Responses

  1. One thing I have wondered about with respect to the studies showing that statin use may help prevent (or prevent advancement of) prostate cancer is whether the benefit is from the statin or from having low or moderate total cholesterol and LDL. In other words, from a prostate cancer perspective, does it make sense to take a statin even if one’s cholesterol levels are good without the statin? Do they ever compare results for people with the same cholesterol levels, with some on statins and some not?

  2. Geoff:

    There has been very little information on this topic to date, primarily, I suspect, because data on cholesterol levels on patients who have not been taking statins may be difficult to collect for prostate cancer patients.

    You will note, however, that these data were available for some of the patients in the study referred to above, and according to the authors, “pretreatment total cholesterol level < 187 and a low-density lipoprotein level < 110" appear to have been associated with longer periods of freedom from biochemical failure regardless of whether the patients were receiving a statin or not.

  3. I asked my oncologist a similar question. Though my LDL was very good at 110, he said I had not reached the “ideal” level of <100, thus for general health but also with an eye to prostate cancer control he prescribed simvastatin. At 11¢ per pill it is certainly a bonus in the cost/benefit calculation. I wish all my medications were so easy to swallow, in a metaphoric and actual sense.

  4. Geoff:

    For what it’s worth … I recently saw an interview with Mark Moyad (MD, MPH and author on several books related to managing prostate cancer) in which he was asked what he was doing to avoid prostate cancer. Even though he has “normal” cholesterol numbers, he was taking a statin. Yes, it’s a sample of one person, but a particular person who (I think) knows a lot about this sort of thing.

  5. You only give the p values of the effects of statins. It would be good to give also the magnitude of the reponses observed.

  6. You would have to look at the actual paper to see these. I do not have access to the full text of the paper.

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