Highlights
- •Statins are potential candidates for secondary prevention in metastatic prostate cancer.
- •Atorvastatin, pravastatin, and rosuvastatin demonstrated greater survival benefits than other types of statins.
Abstract
Objectives
Before launching large clinical trials to confirm the effects of statins in improving
outcomes among men with prostate cancer (PC), the most appropriate target patient
population and the type of statins need to be clearly identified.
Patients and methods
A retrospective cohort study was conducted using the Taiwan Cancer Registry of 2008–2014.
This study included 5749 men with locally advanced and metastatic PC who received
only androgen deprivation therapy (ADT) in the first year after their cancer diagnosis.
Statin users were defined as anyone who was prescribed statins for >28 days. An inverse
probability of treatment-weighted Cox model was used to estimate the effects of statin
use on all-cause mortality and PC-specific mortality (PCSM) while treating the statin
status as a time-dependent variable.
Results
Overall, 2259 patients died, and 1495 of them died of PC during a median follow-up
of 3.6 years from 1 year after their diagnosis. Statin use was associated with significant
reductions in all-cause mortality (hazard ratio [HR] = 0.78, 95% confidence interval
[CI]: 0.70–0.86) and PCSM (HR = 0.76, 95% CI: 0.68–0.86) for metastatic disease and
all-cause mortality (HR = 0.66, 95% CI: 0.54–0.81) for locally advanced disease. Patients
who received atorvastatin, pravastatin, rosuvastatin or pitavastatin showed a stronger
reduction in mortality than those who received other statins. Benefits of statins
were consistently observed in men who received post-diagnostic statins, even in those
with high comorbidities or an old age.
Conclusions
Our results suggest that only atorvastatin, pravastatin and rosuvastatin were associated
with improved survival in advanced PC patients receiving ADT.
Keywords
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Article info
Publication history
Published online: March 01, 2019
Accepted:
November 27,
2018
Received in revised form:
November 19,
2018
Received:
August 17,
2018
Identification
Copyright
© 2019 Elsevier Ltd. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Prostate cancer incidence and mortality among men using statins and non-statin lipid-lowering medicationsEuropean Journal of CancerVol. 112
- PreviewStatins have demonstrated protection against aggressive/late-stage and/or lethal prostate cancer (PC), but prior studies are limited by small populations, short follow-up and unequal health-care access. Research has not demonstrated that non-statin lipid-lowering medications (NSLLMs) provide a similar benefit, which would support a cholesterol-based mechanism. We sought to rigorously test the hypothesis that cholesterol-lowering drugs affect PC incidence and severity.
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- PreviewIn this issue of the European Journal of Cancer, Shao et al. and Van Rompay et al. [1,2] report that statins and, in the latter manuscript, also non-statin lipid-lowering medications appear to improve prostate cancer outcomes, both by retrospective analyses. This adds to the large body of epidemiological studies suggesting a favourable role for statins on the clinical outcomes of men with prostate cancer, but the precise nature of the anticancer effect of these drugs remains controversial. Retrospective studies have an inherent bias because all these men received the statin (or any other lipid-lowering drug) for a medical condition that may influence their prognosis or receiving a statin could be a surrogate for being under more ‘intensive’ medical care.
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