Risk for prostate cancer diagnosis from the Finnish Prostate Cancer Screening Trial

A new paper in the Scandinavian Journal of Urology has provided us with some insights into things associated (and not associated) with risk for a diagnosis of prostate cancer, based on data from > 12,000 participants in the Finnish cohort of the European Randomized Screening for Prostate Cancer (ERSPC) study.

In particular, the research team was interested in assessing any associations between risk for a diagnosis of prostate cancer and factors that included indicators of endogenous androgen production at puberty, male pattern baldness, over-the-counter use of non-steroidal anti-inflammatory drugs (NSAIDs), and use of vitamin supplements.

All 12,740 participants in the third screening round of the Finnish Prostate Cancer Screening Trial were given a survey on possible risk factors for prostate cancer; actual diagnosis of cases of prostate cancer were identified through use of the national Finnish Cancer Registry.

Here are the study results reported by Sarre et al.:

  • 11,795/12,740 men (92.6 percent) competed and returned the survey questionnaire.
  • The average (median) follow-up after the third round of screening was 6.6 years.
  • 757/11,795 men (6.4 percent) were diagnosed with prostate cancer.
  • 21/757 men diagnosed (2.8 percent) died from prostate cancer.
  • Compared to earlier onset of puberty onset, onset of puberty after 15 years of age
    • Was associated with a small but significant reduction in risk for prostate cancer diagnosis (hazard ratio [HR] = 0.87)
    • Was not associated with any change in prostate cancer-specific mortality.
  • Compared to less frequent use of the NSAID ibuprofen, weekly use of ibuprofen
    • Was associated with an overall increase in risk for prostate cancer diagnosis (HR = 1.43)
    • Was associated with  an increase in risk from metastatic prostate cancer (HR = 1.49).
  • There was no evidence of any statistically significant association between use of vitamin supplements and risk for prostate cancer diagnosis.

The study’s abstract does not mention any association between male pattern baldness and diagnosis of prostate cancer, so if there was such an effect we assume it was small and probably non-signifciant.

Sarre et al. draw the obvious conclusions that, based on their study data: there may be an impact from the timing of initiation of endogenous androgen production at puberty on later development of prostate cancer; use of over-the-counter ibuprofen may increase risk for a diagnosis of prostate cancer; and protective effects of vitamin supplements on risk for prostate cancer diagnosis were not evident.

Having said that, we must bear in mind that a follow-up of 6.6 years is short in terms of the development of prostate cancer when it comes to the use of NSAIDs and vitamin supplements. However, the issue related to timing of puberty is of interest since there must have been a 30+ year time delay between onset of puberty and entry of men into this trial.

Perhaps unfortunately (given the size of this study), we have no data as to whether the heights of the patients or the relative lengths of their fingers were associated with prostate cancer risk. Both of these items have been associated with increased risk for prostate cancer in at least some other studies.

4 Responses

  1. “use of over-the-counter ibuprofen may increase risk for a diagnosis of prostate cancer”

    I suspect it is more a need for daily NSAID use; chronic pain, chronic inflammation, and the resulting low exercise levels.

    Effect rather than cause.

  2. Michael:

    At best studies like this can only show associations as opposed to causes and effects.

  3. By contrast, aspirin was protective. Aspirin use seems also to be associated with a modest reduction in prostate cancer-specific mortality (HR = 0.86, 95% CI = 0.78 to 0.96 for total prostate cancer; OR = 0.81, 95% CI = 0.71 to 0.92 for advanced prostate cancer).

  4. Dear Tom:

    To be strictly accurate, what Liu et al. state in the paper you refer to (which is a large meta-analysis) is that their data offer “support for the hypothesis” that aspirin use lowers risk for the diagnosis of prostate cancer in general and for prostate cancer-specific mortality. They do not state that their study proves such an effect.

    It would take multi-year trials of a size comparable to the Prostate Cancer Prevention Trial to actually prove whether use of each specific NSAID had protective effects on risk for prostate cancer diagnosis and progression to metastatic prostate cancer.

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