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Mortality associated with statins in men with advanced prostate cancer treated with androgen deprivation therapy

  • Szu-Yuan Wu
    Affiliations
    Department of Radiation Oncology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Institute of Clinical Science, Zhongshan Hospital, Fudan University, Shanghai, China
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  • Su-Chen Fang
    Affiliations
    College of Nursing, Taipei Medical University, Taipei, Taiwan
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  • Hung-Jen Shih
    Affiliations
    Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Yu-Chin Wen
    Affiliations
    Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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  • Yu-Hsuan Joni Shao
    Correspondence
    Corresponding author: Graduate Institute of Biomedical Informatics, Taipei Medical University, 172-1 Keelung Rd., Section 2, Taipei 106, Taiwan. Fax: +886 2 6638 0233.
    Affiliations
    Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan

    Department of Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA

    Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Published:March 01, 2019DOI:https://doi.org/10.1016/j.ejca.2018.11.032

      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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      Linked Article

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          Statins 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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      • Statins – No more cream for cancer
        European Journal of CancerVol. 112
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          In 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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