From 1995-2016, there were 797 men on AS that satisfied institutional low-risk criteria (Gleason score <7, <4 positive cores, <50% core involvement, and PSA <10 ng/mL). Reclassification at the confirmatory biopsy occurred in 194 (24%) men, 51 (26%) of whom were statin users, leaving 603 men for analysis of progression beyond confirmatory biopsy. Multivariable Cox proportional hazard models assessed statin exposure at diagnosis and time to pathological (failing to meet low-risk criteria at subsequent biopsy) and therapeutic progression (first of pathological progression or initiation of medical therapy). The median age in the cohort (n=603) was 63 years, 23% were statin users, 24% progressed pathologically, and 33% progressed therapeutically over a median follow-up of 60 months. Statin exposure was not significantly associated with pathological (adjusted hazard ratio [aHR] 0.79, 95%CI 0.51‒1.23) or therapeutic (aHR 0.81, 95%CI 0.55‒1.19) progression beyond the confirmatory biopsy, although a non-statistically significant trend was observed. When considering statin exposure as a time-dependent covariate, there was less of an association, while incorporating further covariates (ie. core involvement, BMI, ethnicity, family history) improved the association, although without statistical significance. The strength of the current study is the rigorous statistical methodology, whereas a possible limitation is the single-center experience potentially decreasing generalizability.
In summary, the authors noted that based on these results, there is no support for chemoprevention with statins for men on AS for low-risk prostate cancer. Future directions should incorporate pooled AS series, as well as other potential chemopreventative agents such as metformin.
Presented By: Viranda Jayalath, Princess Margaret Cancer Centre, Toronto, ON, Canada
Co-Authors: Madhur Nayan, Antonio Finelli, Maria Komisarenko, Narhari Timilshina, Neil E. Fleshner, Robert J. Hamilton
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre Twitter: @zklaassen_md at the 72nd Canadian Urological Association Annual Meeting - June 24 - 27, 2017 - Toronto, Ontario, Canada