Columbia University Medical Center/NY Presbyterian Hospital, New York, USA.
Study Type - Prognosis (retrospective cohort) Level of Evidence 2b.
What's known on the subject? and What does the study add? Statin use may reduce the risk of developing prostate cancer. Studies also suggest that the protective effect of statins may be beneficial for prostate cancer patients following treatment. Statin users may also have lower PSA than non-users. Our study agrees with the findings that statin users may have lower PSA than non-users. Contrary to the findings that statins are protective in prostate cancer this study shows no benefit and possible worse biochemical outcome after radical prostatectomy.
To determine the relationship between statin use and biochemical recurrence (BCR) following radical prostatectomy (RP).
A retrospective analysis was performed on 3198 RP patients between 1990 and 2008. Exclusion criteria were neo-adjuvant or adjuvant therapy, follow-up < 2 years, and insufficient pathological or prostate-specific antigen (PSA) data. Statin use was determined from the patient's record. Clinical and pathological variables were compared between statin users and non-users. Kaplan-Meier and multivariate Cox regression analyses were performed to determine the effect of statin use on BCR.
A total of 1261 patients fit criteria for analysis. There were 281 (22%) statin users. Mean age was 60 years and median follow-up was 36 months (mean 43 months). Statin users had a lower median preoperative PSA (6.4) compared with non-users (7.1) (P < 0.05). In all, 80% of statin users had a pathological Gleason sum ≥7 compared with 67% of non-users (P < 0.05). On multivariate analysis, statin use was an independent predictor of BCR (hazard ratio 1.54, P < 0.05). Statin users had a lower 5-year BCR-free survival compared with non-users (75% vs 84%, P < 0.05).
Statin users are at an increased risk for BCR following RP. This finding may be due to the reduction in preoperative PSA potentially delaying diagnosis and/or masking aggressive disease. Further studies are necessary to elucidate the impact of statin medications following prostate cancer therapy.
Ritch CR, Hruby G, Badani KK, Benson MC, McKiernan JM. Are you the author?
Reference: BJU Int. 2011 Mar 31. Epub ahead of print.