AUA 2017: Influence of Statin Intake on PSA Values, Risk of Prostate Cancer Development and Survival in a Prospective Screening Trial Cohort (ERSPC)

Boston, MA ( Chemoprevention of prostate cancer (PCa) has been extensively investigated in the last decades. So far only 5-alpha-reductase-inhibitors (5-ARI) are supported by clinical evidence to have chemo-preventive effect on PCa incidence. Evidence for a similar effect of statins on PCa is conflicting. The interaction between dyslipidemia and carcinogenesis is still to be established. Dr. Kwiatkowski presented a study aiming to analyze the influence of statins intake on PSA values, risk of PCa diagnosis, and overall survival.

This was a population-based analysis including 4,314 men from the European Randomized Study of Screening for Prostate Cancer (ERSPC) database. Data about drug intake, age, family history and symptoms was obtained by a self-administered questionnaire. A trans-rectal ultrasound guided prostate biopsy was performed in men with a PSA-level > 3ng/ml. Tumor stage and grade were registered, incidence and mortality data were obtained as well. PCa incidence and grade, total PSA value, free-to-total PSA and overall survival were compared between statin users and non-users.

Over a follow-up period of 9.6 years men with statin (n=761) exposure had an insignificantly lower risk to be diagnosed with PCa ([stat+] hazard ratio (HR) 0.77, 95 % confidence interval (CI) 0.58 to 1.02. Statin users had a lower prevalence of low risk PCa compared to non-users (p<0.05) at baseline visit, while there was no difference in other PCa risk groups. Interestingly, total PSA values were lower in statin users both for baseline (1.5 vs. 1.8 ng/ml, p<0.001) and follow-up-visits (after four years) (1.8 vs. 2.1ng/ml, p<0.001). Overall mortality was higher among statin users compared to non-users ([stat+] HR 1.67, 95% CI 1.36 to 2.04, however the competing risk analysis demonstrated that PCa incidence was not influenced by overall-mortality.

This study demonstrated that statins intake did not alter overall PCa risk in a statistically significant manner. However, the finding of persistently lower PSA values in statin users is of potential clinical importance. It suggests that PSA cutoff values should be lowered in statin users, otherwise it may introduce potential bias towards delayed PCa detection in this group, especially outside screening setting. On the other hand, lower PSA values may suggest a durable protective effect of statins on PCa development.

Presented By: Maciej Kwiatkowski, Aarau, Switzerland

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre
Twitter: @Goldberghanan

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA