Statins in prevention of prostate cancer progression after radical prostatectomy


A detailed review of treatment data from 1,200 patients treated by radical prostatectomy fails to offer any support for the development of a large, prospective trial of the clinical use of statins as adjunct therapy to prevent biochemical progression in men treated surgically for localized prostate cancer.

The potential value of statins like pravastatin (Pravachol) or atorvastatin (Lipitor) — properly known as HMG-CoA reductase inhibitors — in the management of men with localized prostate cancer as an adjunct to first-line therapy is still unclear. While statins do appear to have potential value in the management of men with progressive forms of prostate cancer after biochemical failure of first-line therapy, the situation in men prior to biochemical failure of first-line therapy is controversial and unresolved at this time.

Chao et al. set out to explore whether statin therapy was associated with any reduction in risk of disease recurrence based on data in the prostate cancer registry of the Kaiser Permanente Southern California (KPSC) health plan. To do this they identified all men in the KPSC prostate cancer registry who had been diagnosed with incident prostate cancer in 2004 and 2005 and who subsequently underwent radical prostatectomy by December 31, 2005. These patients were then followed for up to 5 years after their surgery for

  • Biochemical recurrence, defined as a single PSA measurement > 0.2 ng/ml
  • Clinical disease progression, defined as diagnosis of metastatic prostate cancer or prostate cancer-related death.

Additional information on items like statin use, demographics, comorbidities, patho-clinical data, and outcomes were extracted from KPSC’s electronic medical records.

Here are the results reported by Chao et al.:

  • 1,200 eligible patients were identifiable in the KPSC prostate cancer registry.
    • 37 percent of the patients were pre-surgical users of statins.
    • 56 percent of the patients were post-surgical users of statins.
  • Among the pre-surgical users of statins, compared to the non-users
    • There was no significant evidence of any effect of statin use on biochemical recurrence post-surgery (hazard ratio [HR] = 1.00).
    • There was no significant evidence any effect on clinical disease progression (HR = 0.63).
    • There was no clear evidence of any dose-response relationship (based on duration of use).
  • Among the post-surgical users of statins, compared to the non-users
    • There was no significant evidence of any effect of statin use on biochemical recurrence post-surgery (HR = 1.05).
    • There was no significant evidence any effect on clinical disease progression (HR = 1.20).
    • There was no clear evidence of any dose-response relationship (based on duration of use).

The authors report that, at least in this study, they “found no clear association between overall statin use and risk of disease progression, as well as lack of a monotone dose-response relationship between the use of statins, whether it was use before or after prostatectomy, and prostate cancer disease progression.” They further conclude that “Statin use may not prevent prostate cancer progression following radical prostatectomy” and that ” These findings do not provide support for the pursuit of a prospective clinical trial of statin use as a secondary prevention among surgically treated patients with prostate cancer.”

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