Does statin therapy really extend survival of men diagnosed with prostate cancer?


An analysis of another large cohort of prostate cancer patients (this time from the United Kingdom) has again suggested that there is a reduction in the risk of prostate cancer-specific mortality for patients who are treated with statins after their initial diagnosis with prostate cancer.

The new study by Yu et al. (a Canadian research team) is based on data from a large, population-based electronic database of British men, and is focused on patients who were initially diagnosed with non-metastatic prostate cancer between April 1, 1998, and December 31, 2009 and followed through October 1, 2012.

Here are the core data reported by Yu et al.:

  • The total number of men in the study cohort was 11, 772.
  • The average (mean) follow-up was 4.4 ± 2.9 years.
  • 3,499 deaths occurred during follow-up, and 1,791/3,499 of those deaths (51.2 percent) were prostate cancer specific.
  • Post-diagnostic use of statin therapy was associated with
    • A reduction in risk for prostate cancer-specific mortality (hazard ration [HR] = 0.76)
    • A reduction in risk for all-cause mortality (HR = 0.86); 95% CI, 0.78 to 0.95).
  • Pre- and post-diagnostic use of statin therapy was associated with
    • An even greater reduction in risk for prostate cancer-specific mortality (HR = 0.55)
    • An even greater reduction in risk for all-cause mortality (HR = 0.66)
  • Post-diagnostic use of statin therapy only was associated with
    • A lesser reduction in risk for prostate cancer-specific mortality (HR = 0.82)
    • A lesser reduction in risk for all-cause mortality (HR = 0.91)

Yu et al. conclude — based on these data — that:

Overall, the use of statins after diagnosis was associated with a decreased risk in prostate cancer mortality. However, this effect was stronger in patients who also used statins before diagnosis.

However, we still have no clarity as to exactly why statin therapy should have this effect. Nor do we have any confirmatory data from a large, double-blind, randomized clinical trial. One needs to be very careful in interpreting the results of this type of epidemiological study. It suggests a possibility, but it is not proof of an effect.

7 Responses

  1. Statins have been one of the great life extenders developed within the last 50 years. Particularly for men, statins and blood pressure medicines have had a significant effect in preventing heart disease. When my doctor suggested I start using a starter dose of a statin years ago (I was probably in my early 40s) he explained that recent studies had shown that the risk/benefit of these were so positive that doctors were becoming much more aggressive is using them. (My total cholesteral was about 190, but my HDL was only about 25. I’ve upped the HDL through aerobic exercise. With statins, my total cholesterol is less than 100.) He told me most cardiologists he knew were taking a statin no matter what ther cholesterol level was.

    I don’t about benefits specific to prostate cancer, but they are cheap and in most folks have no noticeable side effects. (Even Lipitor is available as a generic now.)

  2. Dear Doug:

    I don’t think anyone is suggesting that statins are anything except valuable for many men with cardiovascular issues and elevated cholesterol levels … but as yet that hasn’t helped us to understand why they may be beneficial in extending prostate cancer-specific survival.

  3. What about this article: “Statin drugs and prostate cancer: time to consider proactive strategies in patients“? It gives some insights and explanations of the working mechanisms of statins.

  4. Dear Mr/Dr den Hertog:

    The article by Solomon and Mitchell does indeed review some recent hypotheses about how statins may affect progression of prostate cancer based on animal studies. These are scientifically interesting, but (as far as I am aware) we really have no idea whether any of the suggestions proposed is actually what happens in a man with progressive prostate cancer.

  5. It is also worth noting that not all experts are enthusiastic about the constantly expanding recommendations for statin therapy, and there has been a lot of flak about the most recent recommendations for use of this class of drugs (see, for example, this “viewpoint” article, published on-line yesterday in the Journal of the American Medical Association). Statins are not without side effects.

  6. POSSIBLE EXPLANATION FOR SUPERIORITY OF PRE/POST USE

    I’ve seen some research indicating that the beneficial effect of statins against death from prostate cancer seems to increase the longer we take them, and I believe I’ve seen studies demonstrating superiority of 5 years of use over a shorter period. It seems logical that men taking the drugs both before and after diagnosis would be much more likely, on average for the whole group, to have taken them longer than those in the post-diagnosis only group. The average (mean) follow-up is relatively short at 4.4 years, which implies that the average use of statins in the post-diagnosis group would have been well under 5 years.

    I had seen earlier research, before the 5 years of use study, indicating an increased benefit of 3 years, and I was happy when I passed that milestone. I’m now well beyond 5 years.

  7. ONE POSSIBLE MECHANISM OF STATIN IMPACT ON PROSTATE CANCER

    I’ve been at researcher meetings where cholesterol’s role as a precursor to testosterone has been discussed in conjunction with hypotheses about the role of statins in reducing death from prostate cancer. On the advice of a highly regarded oncologist, I have increased my statin dose to drive my HDL even lower than its previous acceptable level.

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