They used the national VA database to identify all men diagnosed with PCa who are receiving ADT and were treated with statin medications for at least 6 months after PCa diagnosis between 2000 and 2008 with follow-up through May 2016. Patients were then stratified based on the type of statins (hydrophilic vs. lipophilic), the cumulative dose of statins (based on WHO defined daily dose for each statin medication), and the total duration of statins use ( < 12 months, 12-24 months, 24-36 months, and >36 months). Multivariable Cox proportional hazards analyses were performed to assess the association between cumulative duration, dose, and type of statin used and prostate cancer-specific survival (PCSS), overall survival (OS) and skeletal-related events (SREs).
A total of 53,582 PCa patients on ADT were included in the study cohort. The median patient age was 74 years, and the majority (65.7%) were Caucasian. Seventy-five percent of patients had Charlson co-morbidity index of ≤1. The median PSA at time of diagnosis was 9.6 ng/dl. On multivariable Cox proportional hazards analysis controlling for various baseline characteristics increased duration > 36 months (HR 0.48, 95% CI 0.46-0.51) and cumulative dose (HR 0.50, 95% CI 0.48-0.53) were associated with improved OS. Similar associations were noted for PCSS and SREs. Use of hydrophilic statins was associated with improved OS (HR 0.81, 95% CI 0.71-0.92) and SREs (HR 0.58, 95% CI 0.36-0.94), but was not associated with PCSS (HR 0.91, 95% CI 0.68-1.22) on Cox proportional hazards multivariable analyses.
Dr. Khemees concluded that there is a dose-response relationship between the dose, duration, and type of statin used in patients with advanced prostate cancer who are treated with ADT. Patients who used a higher dose of hydrophilic statins for a more extended period have improved oncological outcomes. Statins are safe, low-cost medication with minimal side effects and can further be studied in a clinical trial setting in combination with ADT.
Presented by: Tariq Khemees, MD, Department of Urology, University of Wisconsin School of Medicine and Public Health
Written by: Abhishek Srivastava, MD, Society of Urologic Oncology Fellow, Fox Chase Cancer Center, Fox Chase Cancer Center, Philadelphia, PA, Twitter: @shekabhishek at the American Urological Association's 2019 Annual Meeting (AUA 2019), May 3 – 6, 2019 in Chicago, Illinois