Post-RP Statins May Lower PSA Relapse Risk

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SAN FRANCISCO—Initiating statin therapy after radical prostatectomy (RP) may decrease the risk of biochemical recurrence of prostate cancer, new data suggest. 

Previous research has shown that statin treatment initiated before RP is associated with decreased risk for adverse pathological features and PSA relapse.

Researchers at Duke University Medical Center in Durham, N.C., analyzed data from 1,280 men in the Shared Equal-Access Regional Cancer Hospital (SEARCH) database who underwent RP and were not on statins prior to surgery. Of these, 350 (27%) started statin treatment after RP. These subjects had a lower mean age than men who did not take statins (61.5 vs. 62.8 years), higher median BMI (27.5 vs. 27 kg/m2), and lower median pre-operative PSA levels (6.5 vs. 7.8 ng/mL). After controlling for clinical and pathological parameters, post-RP statin use was associated with a significant 39% decreased risk of biochemical recurrence defined as post-RP PSA levels greater than 0.2 ng/mL, two PSA determinations of 0.2 ng/mL or higher, or receipt of secondary treatment due to rising PSA.

“Our findings did not surprise me at all,” said lead investigator Lionel Bañez, MD, Assistant Professor of Surgery in the Division of Urologic Surgery. “We previously found that pre-RP statin-use was associated with decreased risk for recurrence. We also found that pre-RP statin-use was linked to decreased tumor inflammation - a pathologic hallmark that has been linked to prostate cancer progression. It makes sense that statin-use after surgery could be potentially beneficial.” He presented study findings at the American Urological Association annual meeting.

If larger trials confirm that post-RP statin initiation lowers biochemical recurrence risk, even patients who were not taking statins prior to surgery may derive some cancer-related benefit moving forward by initiating statin-intake post-operatively, Dr. Bañez said.

He pointed out that the study is limited by its retrospective design, and acknowledged that the statin and non-statin groups may have differences not accounted for in the analyses. The researchers were unable to analyze diet and lifestyle behaviors, comorbidities, or the intensity of post-operative follow-up.

Study co-investigator Stephen Freedland, MD, Associate Professor of Urology and Pathology, said the magnitude of benefit from statins found in this study is comparable to that of radiation therapy.

“If confirmed in trials, this would be very profound,” Dr. Freedland said. “It is not actually that far from being as effective as radiation therapy, which has potentially significant side effects.”  Moreover, patients receive the other benefits of statins, such as a reduction in cardiovascular disease risk.

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