Statin Use After Prostate Cancer Surgery May Lower Recurrence Risk
Study of RP patients reveals a decreased risk of PSA relapse in those who used statins.
Postoperative use of statins is associated with a decreased risk of biochemical recurrence (BCR) following radical prostatectomy (RP) for prostate cancer, according to a new study.
In a study of 1,146 RP patients—none of whom took statins prior to RP—Emma H. Allott, PhD, of Duke University School of Medicine in Durham, N.C., and colleagues found that post-RP statin use was associated with a significant 36% decreased risk of BCR, after adjusting for clinical and pathological characteristics.
Post-RP statin use remained significantly associated with decreased BCR risk after adjusting for preoperative serum cholesterol levels. When the investigators stratified findings by race, they found that postoperative statin use was associated with a significant 51% decreased risk of BCR among non-black patients and a non-significant 18% lower risk among blacks, the researchers reported online ahead of print in BJU International.
Of the 1,146 patients, 400 (35%) used statins after RP and before BCR. The investigators defined BCR as a single PSA value greater than 0.2 ng/mL, 2 consecutive levels at 0.2 ng/mL, or a secondary treatment for detectable postoperative PSA. Overall, compared with patients who did not use statins after RP, those who did had significantly lower median preoperative PSA levels (5.9 vs. 7.1 ng/mL), higher median body mass index (27.6 vs. 27.1 kg/m2), lower biopsy and pathologic Gleason scores, fewer positive margin (40% vs. 50%), and less seminal vesicle invasion (5% vs. 11%). Additionally, post-RP statin users had higher median serum cholesterol before surgery (202 vs. 185 mg/dL).
Previously, Robert J. Hamilton, MD, MPH, of Duke University School of Medicine, and collaborators reported in Cancer (2010;116:3389-3398) that preoperative statin use was associated with a significant 30% decreased risk of BCR after adjusting for multiple clinical and pathologic factors. The finding was based on an analysis of data from 1,319 RP patients in the Shared Equal Access Regional Cancer Hospital (SEARCH) database.
Other studies, however, have yielded conflicting findings. Researchers from Kaiser Permanente Southern California recently published a study in BJU International (2013;111:954-962) showing no significant association between pre- or postoperative statin use and risk of BCR or clinical progression of disease following surgery. The study, which included 1,200 men, found no clear dose-response relationship for duration of statin use. Moreover, a retrospective study of 6,842 RP patients—of whom 2,275 (33.3%) were statin users—found no independent association between statin use and BCR risk, according to a paper published in Prostate Cancer and Prostatic Diseases (2013;16:367-371). A systematic review and meta-analysis published in the Annals of Oncology (2013;24:1427-1434) concluded that statins are associated with a significant improvement in recurrence-free survival among patients who received radiotherapy, but not among patients treated with RP.