More on statins and the management of prostate cancer

A recent data analysis for the Danish national health registry systems has once again provided confirmation of a link between statin use and risk of prostate cancer-specific mortality.

However, once again, the authors stress that they cannot tell, from their data, whether this effect is “causal”. In other words, we still don’t know whether it is the actual taking of a statin that can reduce risk for prostate cancer-specific mortality in men diagnosed with prostate cancer. (Yes, there are other possible explanations for results like this from registry data of this type.)

What Larsen et al. have shown is that in their study of data from > 31,500 men diagnosed with prostate cancer between 1998 and 2011,

Postdiagnosis statin use was associated with reduced mortality from prostate cancer.

The authors identified all patients in Denmark diagnosed with incident prostate adenocarcinoma between 1998 to 2011. They then retrieved all available data on tumor and patient characteristics, drug use, and primary treatment for these patients, and used the accumulated data to provide the following results:

  • 31,790 patients met criteria for inclusion in the database.
  • Average (median) patient follow-up was 2.8 years from 1 year after diagnosis.
  • During the follow-up period
    • 7,365/31,790 patients (23.2 percent) died of prostate cancer.
    • 11,811/31,790 patients (37.2 percent) died from other causes.
  • Post-diagnosis use of statin therapy was associated with adjusted hazard ratios of
    • 0.83 for prostate cancer-specific mortality
    • 0.81 for all-cause mortality
  • No substantial impact was apparent based on such matters as estimated dose or type of statin, clinical stage, Gleason score, or pre-diagnosis use of statin therapy, but
  • Compared to the prostate cancer-specific mortality rates shown in the overall analysis, slightly lower hazard ratios for prostate cancer-specific mortality with post-diagnosis use of statin therapy were shown by
    • Men diagnosed early in the study period
    • Men who underwent radical prostatectomy
    • Men treated with endocrine therapy (i.e., men treated with some form of androgen deprivation therapy)

3 Responses

  1. Short Follow-up with Short Measured Statin Use, But One More Encouraging Evidence of Statins for PC Patients

    As a patient who started taking a statin many years ago because of what appeared to be a benefit against prostate cancer, news about statins and prostate cancer still catches my attention, and thanks Sitemaster as always for helping us view the information we need. I’m pleased to see that this piece of evidence is consistent with a growing mound of evidence that consistently indicates a benefit for statins for survival. A few facts stood out:

    — An extraordinarily high proportion of these Danish patients — nearly a quarter — died of prostate cancer (23.5%)! Wow! And Ugh! That is a far higher percentage that were dying of prostate cancer in the US during the same period. Back in the 1970s, about a third of men diagnosed in the US were dying of prostate cancer within 5 years, but survival had improved to the upper 90%s by 1998 when the Danish study started and reached nearly 100% by 2011 when it ended. I suspect part of the difference is due to the difference in latitude of the US and Denmark, which seems to make quite a difference in prostate cancer survival generally, perhaps due to lower vitamin D levels at higher latitudes, as some studies have suggested. But that’s speculating, and I’m puzzled by this really high mortality figure for Denmark. Any help?

    — It would be nice to see additional follow-up in the future as, per the abstract, follow-up was rather short: “… median follow-up of 2.8 years (interquartile range, 1.3 to 5.1 years)….”

    — Similarly, my impression as a layman prostate cancer survivor of a challenging case has been that statins seem to have an increased benefit the longer you are on them, at least up to 5 years, and in this study statin use was defined, per the abstract, as two or more prescriptions, which opens the possibility for fairly short use of statins by a possibly large proportion of the patients defined as statin users. At least in the open access abstract we do not have much information about the likely average duration of statin use. For instance, my wife would qualify as a statin user per the study’s criteria, but she experienced disabling muscle pain (“like a lightning storm throughout the body”) from a variety of statins at various doses/regimens and had to cease taking them within half a year (with 6 months for recovery) — a fairly uncommon but not rare side effect that seems to be gaining increasing recognition. (Fortunately, she does very well on the anti-cholesterol drug Zetia, but Dr. Charles “Snuffy” Myers has stated that Zetia, which is in a different class of drugs, does not have the same anti-prostate cancer effect as the statins do.)

    Despite these negative issues, which reflect the difficulties of doing such studies, the authors have done us a service by taking this look at their data.

    Statins were mentioned favorably by a number of speakers at the September 2016 PCRI/Us Too Conference on Prostate Cancer at Los Angeles, with no unfavorable comments except for dealing with side effects), especially by Dr. Myers (as on DVD Disc 2 2:17:08 – 2:20:15, with Dr. Mark Moyad, especially highlighting the statin drug pitavastatin (Livalo) for patients tending to become pre-diabetic or diabetic when using other statin drugs), and Disc 4 3:01:20 – 3:06:32, 3:20:55 – 3:22:03, and elsewhere).

  2. Dr. Myers has long advocated that LDL feeds prostate cancer cells and should be reduced using a statin, exercise, and diet. I recall he prefers to use simvastatin. I use pravastatin and have taken 20 mg/day for 10 years, as a preventive. I also take 500 mg metformin 2x/day but am not diabetic. My only issue with it is loss of weight. I am down to 148 lb, but have also been on a Mediterranean diet for 4 years — no meat other than wild salmon. I’m concerned about lack of protein but blood test is in range.

    This is also an interesting article regarding LDL: “Aggressive prostate cancer makes use of bad cholesterol.”

  3. Dear Robert:

    I would just point out that a Mediterranean diet doesn’t necessarily imply no meat at all (other than your wild salmon). It just means that the amount of meat should be limited.

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