Does concurrent statin therapy help men who have EBRT for localized disease?

We know that statin therapy appears to lower risk for prostate cancer and to increase the overall survival of men diagnosed with prostate cancer. However, what we don’t know (yet) is whether statin therapy during and after specific types of treatment has prostate cancer-specific outcome benefits.

We should preface this discussion with the reminder that everything we currently know about the impact of statins (drugs like simvastatin, atorvastatin/Lipitor, and rosuvastatin/Crestor) on prostate cancer is based on retrospective analysis of data collected for other reasons. There have been no prospective studies (that we are aware of, to date) designed or published that assess the ability of statin therapy to prevent prostate cancer or improve outcomes of prostate cancer therapy. Retrospective data analysis always has to be interpreted with great caution.

Kollmeier et al. wanted to explore the potential impact of statin therapy on biochemical progression-free survival and metastasis-free survival after high-dose radiotherapy for localized prostate cancer. To do this, they conducted a retrospective analysis of data from a total of 1,711 men initially diagnosed with clinical stage T1-T3 prostate cancer who were subsequently treated with conformal external beam radiation therapy (EBRT) to a median dose of 81 Gy during 1995-2007.

Their initial analysis showed that:

  • Pre-EBRT medication data were available for 1,681 patients.
  • 382/1,681 patients (23 percent) were taking a statin at the time of diagnosis and continued to do so during EBRT.
  • 947 patients received a short-course of neoadjuvant and concurrent androgen-deprivation therapy (ADT) along with their EBRT.
  • Median patient follow-up was 5.9 years.

When it came to data specific to patient outcomes, Kollmeier et al. were able to show that:

  • The 5-year PSA relapse-free survival (PRFS) rate for statin patients was 89 percent, compared with 83 percent for those not taking statins.
  • The 8-year PRFS rate for statin patients was 80 percent, compared with 74 percent for those not taking statins.
  • In a multivariate analysis, the use of statins, having low-risk prostate cancer, and the use of ADT were associated with improved PRFS.
  • Only high-risk patients in the statin user-group demonstrated improvement in PRFS.
  • Across all groups, statin use was not associated with any improvement in distant metastasis-free survival (DMFS).
  • By comparison, lower risk group and use of ADT did predict improved DMFS.

The authors first conclude that, in their patient cohort, the use of statin therapy during high-dose EBRT for clinically localized prostate cancer was associated with a significant improvement in PRFS in high-risk patients.They further conclude that, “These data suggest that statins have anticancer activity and possibly provide radiosensitization when used in conjunction with RT in the treatment of prostate cancer.”

It would have been helpful to know what percentage of the patients in this study started statin therapy within (say) a year of completion of their initial treatment for prostate cancer. These data may be available in the full text of the current article. We raise this only because these patients should arguably be excluded from the comparator set of patients in order to truly understand the effect of statins before and during radiation to non-use of statin therapy. However, these data do seem to further suggest an effect of statin therapy — in this case on the outcomes of a subset of men being treated for prostate cancer with high-dose EBRT.

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