Statin Use Reduces Cancer-Specific and All-Cause Mortality in Patients With Nonmetastatic Prostate Cancer
In a study reported in the Journal of Clinical Oncology, Oriana Yu, MD, of Jewish General Hospital in Montreal, and colleagues assessed the association of statin use with prostate cancer mortality and all-cause mortality in men with nonmetastatic prostate cancer. They found that postdiagnostic statin use was associated with significantly reduced cancer-specific and overall mortality, with the treatment effect being greatest in men initiating statin use prior to prostate cancer diagnosis.
Study Details
The study involved a cohort of 11,772 men newly diagnosed with nonmetastatic prostate cancer between April 1998 and December 2009 and followed until October 2012 who were identified from four UK population-based electronic databases (United Kingdom National Cancer Registry, Clinical Practice Research Datalink, Hospital Episode Statistics database, and Office for National Statistics database).
Among all men, mean age at cohort entry was 71 years and mean follow-up was 4.4 years. A total of 3,407 men were statin users before cancer diagnosis; statin users were more likely to be ever-smokers (66% vs 50%), obese (23% vs 15%), have a higher prevalences of comorbidities, and to have used antidiabetic agents, antihypertensive agents, and aspirin.
A total of 3,499 deaths occurred, including 1,791 from prostate cancer. Rates of prostate cancer mortality and all-cause mortality were 34.8 per 1,000 per year and 67.9 per 1,000 per year, respectively.
A multivariate analysis of the effect of statin use on mortality was adjusted for age, year of prostate cancer diagnosis, ethnicity, excessive alcohol use, smoking status, obesity, chronic kidney disease, myocardial infarction, ischemic stroke, transient ischemic attack, peripheral artery disease, previous cancers, prostate-specific antigen level, Gleason score, metformin, sulfonylureas, thiazolidinediones, insulins, other oral antihypoglycemic agents, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, diuretics, other antihypertensive drugs, aspirin, other nonsteroidal anti-inflammatory drugs, 5α-reductase inhibitors, prediagnostic statin use, prostate-specific antigen testing activity, prostatectomy, radiation therapy, chemotherapy, and androgen deprivation therapy.
Benefit of Postdiagnosis Statin Use
On multivariate analysis, use of statins after diagnosis was associated with a 24% reduction in risk of cancer-specific mortality (adjusted hazard ratio [HR] = 0.76, 95% confidence interval [CI] = 0.66–0.89) and a 14% reduction in risk of all-cause mortality (adjusted HR = 0.86, 95% CI = 0.78–0.95) compared with no statin use after diagnosis.
For both prostate cancer mortality and all-cause mortality, increased length of postdiagnosis statin treatment and increased cumulative dose were significantly associated with improved survival (P < .001 for all). For example, cumulative use ≥ 36 months and cumulative defined daily dose ≥ 1,096 were associated with a 39% reduction (HR = 0.61, 95% CI = 0.49–0.75) and 43% reduction (HR = 0.57, 95% CI = 0.46–0.72) in risk for prostate cancer mortality and an 18% reduction (HR = 0.88, 95% CI = 0.69–0.97) and 15% reduction (HR = 0.85, 95% CI = 0.72–1.00) in risk for all-cause mortality.
Stronger Effect of Prediagnosis Use
On multivariate analysis adjusting for all the listed factors except prediagnosis statin use, the beneficial effect of postdiagnosis use of statins was even greater among those who also used statins prior to diagnosis and significantly greater among these patients compared with those who used statins only after diagnosis.
Prediagnosis statin use was associated with a 45% reduction in risk of cancer-specific mortality (adjusted HR = 0.55, 95% CI = 0.41–0.74) and a 34% reduction in risk of all-cause mortality (adjusted HR = 0.34, 95% CI = 0.53–0.81). Use of statins only after diagnosis was associated with an 18% reduction in risk for cancer-specific mortality (HR = 0.82, 95% CI = 0.71–0.96; P = .02 for interaction) and a borderline significant 9% reduction in risk for all-cause mortality (HR = 0.91, 95% CI = 0.82–1.01; P = .01 for interaction).
The investigators concluded, “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.”
The study was supported by the Canadian Institutes of Health Research.
Laurent Azoulay, PhD, of Jewish General Hospital, is the corresponding author for the Journal of Clinical Oncology article.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
