The “Aspirin in Reducing Events in the Elderly” (ASPREE) trial

Your sitemaster has just been made aware of a trial that has been ongoing since 2010. However, it may have implications for determining whether regular aspirin therapy can actually lower risk for prostate cancer-specific mortality.

The ASPREE trial has enrolled some 19,000 patients (male and female) who have been randomized to treatment with a daily dose of a 100 mg enteric-coated aspirin or to a placebo. The primary endpoint is death from any cause or incident, dementia, or persistent physical disability. In other words, it may be possible, as a result of this trial, to be able to tell whether the men randomized to a daily dose of aspirin are at lower risk for death from prostate cancer than the men taking the placebo.

However, it is also possible that the trial will be too short to determine any effect on prostate cancer mortality because the follow-up period is only going to be for 8 years from the time the first patients were enrolled in 2010. One can often live for 20+ years after a diagnosis of prostate cancer, so it is going to be hard to know whether the ASPREE trial is going to offer us any insights at all into effects of a daily aspirin on prostate cancer mortality.

The men who have enrolled in this trial also have a strong likelihood to be “non-average” — in the sense that they may well be men who exhibit a higher than average level of “health-seeking” behaviors. If that is the case, they may well also be more likely to be men who seek and obtain regular PSA testing, which then makes them more likely than the average to be diagnosed with early stage prostate cancer and less likely to be diagnosed with aggressive, later-stage disease.

We’re just going to need to wait until 2018 to see what comes out of the ASPREE trial … or not.

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