Of statins and the prevention and treatment of prostate cancer

The question of whether or not to take a statin to either prevent or actually help in the treatment of prostate cancer has potentially just become moot for many men in America … thanks to new guidance from the US Preventive Services Task Force (USPSTF).

The USPSTF, in very recent guidance, is now recommending that all Americans between the ages of 40 and 75 either take or consider taking a low to moderate dose of a statin if they have an elevated risk for a heart attack and any one of the following additional risk factors: a high cholesterol level, high blood pressure, diabetes, or a history of smoking. (See the full article in the Journal of the American Medical Association and also this commentary on the Reuters web site.)

The goal here, of course, has nothing to do with prostate cancer treatment and everything to do with risk for serious cardiovascular disorders (heart attacks specifically included).

Your sitemaster is uncertain exactly what percentage of males aged between 40 and 75 in America would meet the criteria specified by the USPSTF for statin use under this guidance, but he suspects it is a very high percentage, given our eating (and drinking) habits, our tendency not to exercise sufficiently, and our generally sedentary life style. For more information on risk for serious heart disease among American males, click here.

The USPSTF guidance does come with some degree of risk for patients because taking statins does come with some degree of risk for side effects that can include things like muscle aches, diabetes, fatigue, weakness, and effects on memory. However, there seems to be a considerable diversity of opinion among experts about just how common and serious such side effects really are.

The USPSTF guidance is limited to people aged between 40 and 75 because there is insufficient data to support a recommendation for persons of 76 years of age and older.

From a prostate cancer perspective, the point here is that if most American men at risk for prostate cancer are going to be taking a statin anyway by the time they get to age 50 or so, then the question of whether taking a statin will be helpful in the management of their prostate cancer is going to be unanswerable, because they are already going to be taking one.



7 Responses

  1. What concerns me about this guidance is that it exempts the primary care physician from monitoring lipids. I just had to lean heavily on mine to get tested because he claims it is not necessary since I take a statin.

    In my own case, my total cholesterol is above the limit, even though my HDL is high and the ratio is low. Have to ask whether I never need another test just because I am taking a statin – is it the right statin and the right dose? How would you ever know?

  2. Interesting post. Thank you.

  3. Dear Rick:

    Get a better primary care physician. Anyone who is taking a statin because they have an elevated cholesterol level should be having their cholesterol levels checked on an annual basis at least. This guidance absolutely does not exempt physicians from checking cholesterol levels at all. I have no idea why you would think that.

  4. I am a big believer that we prostate cancer patients should get our cholesterol down, and statins are a fine way to do that. My impression is that the big payoff is in avoiding death from prostate cancer, rather than other objectives, such as avoiding the disease altogether. I have done well with simvastatin for many years, though I have a hunch I am able to avoid fairly minor muscle soreness by keeping the dose low.

    That said, my wife had a miserable experience with at least three statins at various doses and schedules (such as intermittent). She had debilitating, highly irritating muscle pain, and it took us a few months, working with her thoughtful but skeptical doctor, to figure out that statins were the cause. Finally she and the doctor figured out that she was able to get her cholesterol down with Zetia, which works by a different mechanism, and which did not cause her pain.

    I learned an important lesson from researching statins as I tried to help my wife. While the clinical trial evidence indicated a very low risk of muscle soreness and pain due to statins — which I fully believed at the time, recent evidence suggests the trials somehow were getting a false low reading on the incidence of bothersome soreness and pain. Once again, though we rely on evidence from trials, we need to remain alert and keep our minds in gear.

  5. I’ve been contemplating that move, Mike … especially since he opposes PSA testing too. On other scores he is good though.

    The PCP argues that the PSA is redundant — not me; I insisted on a test this year.

  6. Dear Jim:

    We have known for years that there is a relatively small subset of patients who — presumably for metabolic and biochemical reasons — get significant muscular side effects to treatment with statins. However, as I understand it, we still really have no clue why this happens.

    In contrast to your and your wife’s experience, I have been taking high levels of different statins since 2005 (simvastatin, atorvastatin, rosuvastatin) and I haven’t ever had the slightest indication of any form of side effect that I am aware of.

    My suspicion is that just as some people are allergic to aspirin, there are also people who are allergic to statins, and that allergic reaction expresses itself as muscular pain.

    There is no known drug that doesn’t have side effects in at least some people.

  7. Dear Sitemaster:

    Yes, I too was once on a higher dose and felt I tolerated it quite well. As I was familiar with the research that indicated a very low incidence of generally mild muscular side effects, it took me a while to understand that my wife’s complaints were due to a statin. Since then I’ve been paying more attention to news and research about statins, and my impression is that somehow a considerably higher incidence of bothersome and burdensome muscular problems flew under the radar of the clinical trials.

    I am glad that statins — some of them dirt cheap — are highly effective and easily tolerated for many of us. But I’m also glad there is at least one alternative class of drugs (e.g., Zetia) and that research may soon indicate wide anti-cholesterol benefit for another new class of drugs, the PCSK9 inhibitors, which were approved by the FDA last year. Favorable research, led by the Cleveland Clinic’s Dr. Steve Nissen and Stephen Nichols of the South Australian Health and Medical Research Institute, on Repatha (evolocumab) was reported in the Washington Post this morning based on trial results presented yesterday at a meeting of the American Heart Association.

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