Use of non-steroidal anti-inflammatory drugs and prostate cancer survival in the finnish prostate cancer screening trial.

BACKGROUND - Growing evidence suggests that aspirin is associated with decreased prostate cancer (PCa) mortality. The effect of other NSAID use on risk of PCa death remains controversial. We examined prostate cancer survival among aspirin and other NSAID users in the Finnish Prostate Cancer Screening Trial.

METHODS - A total of 6,537 men were diagnosed with prostate cancer in 1996-2009 among the 80,144 men in the trial and 617 died from prostate cancer during the median follow-up of 7.5 years after the diagnosis. Prescription drug purchases information was obtained from the national reimbursement database. We calculated hazard ratios and 95% confidence intervals for PCa-specific survival using multivariable-adjusted Cox regression analysis separately for NSAID and aspirin usage before and after the diagnosis.

RESULTS - We observed an increased risk of PCa death associated with both pre- and post-diagnostic NSAID usage (HR 1.30, 95%CI 1.07-1.58 and HR 2.09, 95%CI 1.75-2.50, respectively). An increasing risk trend was observed by cumulative dose and intensity of NSAID use. When the last three years were excluded from the analysis, the death risk diminished to a protective level (HR 0.42, 95%CI 0.34-0.51 and HR 0.30 95%CI 0.24-0.39). Aspirin use was not significantly associated with prostate cancer survival.

CONCLUSIONS - The survival decrease among NSAID users is likely explained by symptomatic treatment of metastatic pain in patients with advanced PCa. However, results of the lag time analysis support previous findings of a possible preventative action of NSAIDs. Prostate 75:1394-1402, 2015. © 2015 Wiley Periodicals, Inc.

Prostate. 2015 Sep;75(13):1394-402. doi: 10.1002/pros.23020. Epub 2015 Jun 12.

Veitonmäki T1,2, Murtola TJ1,3, Määttänen L4, Taari K5, Stenman UH6, Tammela TL1,3, Auvinen A2.

1 Department of Urology, Tampere University Hospital, Tampere, Finland.
2 School of Health Sciences, University of Tampere, Tampere, Finland.
3 School of Medicine, University of Tampere, Tampere, Finland.
4 Finnish Cancer Registry, Helsinki, Finland.
5 Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
6 Department of Clinical Chemistry, Helsinki University Hospital, Helsinki, Finland.