CUA 2017: Statin Use and Time to Prostate Cancer Progression in Men Undergoing Active Surveillance

Toronto, Ontario (UroToday.com) At the prostate cancer poster session at the CUA 2017 annual meeting, Dr. Viranda Jayalath and colleagues presented their experience with statin use among men undergoing active surveillance (AS) for low-risk prostate cancer. Certainly, uptake rates of AS for appropriate men with low-risk prostate cancer are improving. Preclinical data support a protective effect of statins among patients with prostate cancer, however to date there is limited clinical data in the AS setting. The objective of this study was to provide a single center experience with statin use for men with prostate cancer on AS. 

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
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