High cholesterol levels are associated with an increased short-term risk of prostate cancer (PCa), particularly aggressive PCa, according to a new study. Long-term risk, however, may be diminished.
Men in the second and third tertiles of total cholesterol had a significant 27% and 26% increased overall risk of PCa, respectively, compared with those in the first tertile after a 3-year lag time (no one diagnosed with PCa in the 3 years following the measurement), investigators in Finland led by Teemu J. Murtola, MD, of the University of Tampere, reported in Prostate Cancer and Prostatic Diseases.
In the main analysis (not considering lag time), men in the highest vs lowest tertile of total cholesterol and those with LDL cholesterol levels above 3 mmol/L (vs lower levels) had a significant 42% and 38% increased risk of high-grade (Gleason 8–10) PCa, respectively.
In a 20-year lag time analysis, men in the highest vs lowest tertile of total cholesterol had a 62% decreased overall risk of PCa. Triglyceride levels were not significantly associated with overall PCa risk.
In addition, 10-year lag time analyses revealed no significant association between any lipid measurements and overall PCa risk.
The study population included 17,696 men, of whom 2404 were diagnosed with PCa during a 17-year median follow-up. The first, second, and third tertiles of total cholesterol were 4.41 mmol/L or less, greater than 4.41 to 5.12 mmol/L, and greater than 5.12 mmol/L, respectively.
Dr Murtola and colleagues noted that cholesterol measurements for 10- and 20-year analyses were available only for a limited number of men, so findings should be interpreted with caution. The authors pointed out that the decreased in PCa risk observed in the 20-year lag time analysis could be explained by competing risks because men with higher total cholesterol levels are at elevated risk of death from cardiovascular causes.
“In studies like these, cholesterol can be linked with prostate cancer both biologically and through screening,” commented Stephen J. Freedland, MD, of Cedars-Sinai Medical Center in Los Angeles, who has studied the link between cholesterol and PCa risk but was not involved in the new study. “Men with high cholesterol may be sicker, see their doctors more often, get screened more, etc. Thus, it is very hard to tease out biological causes. However, this [study] adds further data to support that higher cholesterol is linked with more aggressive prostate cancers: more Gleason 8–10 disease.”
Murtola TJ, Kasurinen TVJ, Talala K, et al. Serum cholesterol and prostate cancer risk in the Finnish randomized study of screening for prostate cancer. Prostate Cancer Prostatic Dis. 2018; published online ahead of print.