Does regular anticoagulant therapy really reduce risk of prostate cancer mortality?

A study based on the CaPSURE database, and just published in the Journal of Oncology, has again suggested that prostate cancer patients who are regular users of anticoagulant are a lower risk of prostate cancer-specific mortality than non-aspirin users.

As pointed out in an article in the New York Times today, this is the second study this year to suggest that regular use of anticoagulant use by men who already have a diagnosis of prostate cancer may lower their risk for prostate cancer-specific mortality.

The new paper by Choe et al. is based on a careful analysis of data from 5,955 men diagnosed with and treated for localized prostate cancer on whom data has been compiled in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database.

Here is a summary of the findings of the new analysis:

  • All 5,955 patients had received first-line therapy with either radical prostatectomy or radiotherapy
  • 2,175/5,955 (37 percent) of the patients (the AC group) were receiving regular anticoagulant therapy with
    • Warfarin (Coumadin)
    • Clopidogrel (Plavix)
    • Enoxaparin
    • Aspirin
  • Average (median) follow-up was 70 months from first-line treatment (nearly 6 years)
  • Compared to men who were not receiving regular anticoagulant therapy (the non-AC group) men in the AC group were
    • At significantly lower absolute risk for prostate cancer-specific mortality (3 vs. 8 percent at 19 years)
    • At significantly lower absolute risk for disease recurrence and bone metastasis
  • When a subgroup analyses were conducted, the reduction in risk for prostate cancer-specific mortality was
    • Most apparent in men with high-risk disease
    • Primarily associated with the regular use of aspirin as opposed to the other anticoagulants
  • The benefit from anticoagulant therapy appeared to be present across treatment types

Choe et al. conclude that

  • Regular treatment with anticoagulants, and particularly with aspirin, was associated with a reduction in risk of prostate cancer-specific mortality among men receiving standard forms of first-line treatment for localized prostate cancer.
  • This association was most apparent among the patients with high-risk prostate cancer.

Now these are not data from a randomized clinical trial, and so they need to be interpreted with caution. Strictly speaking, these data are “hypothesis generating” as opposed to offering actual clinical guidance.  They need to be considered in conjunction with the data published by Zaorsky et al. (mentioned above) that are based on another retrospective analysis of some 2,000+ men with localized prostate cancer, all treated with radiation therapy, and suggestive of the idea that aspirin use or statin use lowered risk for prostate cancer-specific mortality.

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