The following article features coverage from the American Urological Association (AUA) 2019 meeting. Click here to read more of Renal & Urology News’ conference coverage.

CHICAGO—Use of hydrophilic statins, but not hydrophobic statins, is associated with a significantly lower risk of being diagnosed with prostate cancer (PCa), according to study data presented at the 2019 American Urological Association annual meeting.

To investigators’ knowledge, the study is the first to demonstrate a clear advantage of hydrophilic over hydrophobic statins in terms of PCa outcomes.

Men who had ever used hydrophilic statins, compared with those who never did, had a significant 18% decreased risk of being diagnosed with PCa and 20% decreased risk of undergoing an additional prostate biopsy, Hanan Goldberg, MD, a uro-oncology clinical fellow at the University of Toronto, and colleagues reported.

Use of both types of statins was associated with a significantly decreased risk of dying from PCa, but the protective effect was more pronounced with hydrophilic statins. Ever-use of hydrophilic statins was associated with a 32.4% decreased risk of PCa-specific death compared with never- use, whereas ever-use of hydrophobic statins was associated with a 17.2% decreased risk compared with never-use.

Additionally, each cumulative 6 months of hydrophilic statin use was associated with a significant 3.3%, 2.7%, and 4.3% decreased risk of having another prostate biopsy, being diagnosed with PCa, and dying from it, respectively. The investigators found no significant association between 6-month cumulative use of hydrophobic statins and the risk of having another prostate biopsy or being diagnosed with PCa. Each 6-month cumulative use of hydrophobic statins, however, was associated with a significant 1.7% decreased risk of PCa-specific death.

The investigators adjusted the risks for use of proton pump inhibitors, alpha blockers, 5-alpha reductase inhibitors, chloroquine, dipyridamole, and glaucoma eye drops.

“Statins are usually prescribed to men without any specific predilection for a specific type of statin,” Dr Goldberg told Renal & Urology News. “In this study, we present data showing clear evidence to choose hydrophilic statins … in men in need of this treatment.” These medications include pravastatin and rosuvastatin.

The study included 21,562 men aged 66 years or older from Ontario who had a negative first prostate biopsy from 1994 to 2016. Of these, 11,112 (51.5%) had diabetes mellitus treated with medications, 5187 (24%) were diagnosed with PCa, 7861 (36.5%) died, and 647 (3%) died from PCa.

Previous studies have suggested that statins, as a group, lower the rate of PCa diagnosis, recurrence, and death. Preliminary in vitro data have shown that hydrophobic statins may have an advantage over hydrophilic statins. Dr Goldberg’s team said they were surprised by their finding that hydrophilic statins offered advantages over hydrophobic statins in terms of PCa outcomes.

Hydrophilic statins are liver-specific and, consequently, are thought to decrease the risk of adverse effects, the authors explained. These statins do not penetrate the blood-brain barrier and are excreted largely unchanged, they noted. In contrast, hydrophobic statins enter cells by passive diffusion. They are widely distributed in different tissues and penetrate the blood-brain barrier. These statins can cause metabolic problems including impaired insulin secretion and promotion of insulin resistance.

Previous studies looking at the effect of statins on PCa outcomes have yielded conflicting results, with some studies showing benefit and others no benefit. “We believe the reason for this was that statins were analyzed as a whole group and not divided into hydrophilic and hydrophobic, as was performed in our study.”

Read more of Renal & Urology News’ coverage of the AUA 2019 meeting by visiting the conference page.

Reference

Goldberg H, Moshin F, Klaasen Z, et al. Impact of hydrophilic statins on prostate cancer. Presented at the 2019 American Urological Association annual meeting held May 3-6 in Chicago. Abstract MP18-04.