Advanced prostate cancer may be slowed by statins

Durham, NC-Men on statin therapy before radical prostatectomy had a 30% lower risk of cancer recurrence, according to an analysis of the Shared Equal Access Regional Cancer Hospital (SEARCH) database, a large prostate cancer database.

Statin users also were more likely to have early-stage disease at diagnosis, said first author Robert J. Hamilton, MD, MPH, a urologist at the University of Toronto.

"If our findings are confirmed in other studies, they suggest that statins may slow prostate cancer progression after radical prostatectomy," said Dr. Hamilton, who was at Duke University in Durham, NC, at the time of the study. "However, at this point, we cannot say with confidence that statins reduce the risk of recurrence after radical prostatectomy. A randomized clinical trial would be needed to provide a definitive answer."

"To date, no studies have looked at the influence of statin medication use among men undergoing surgery," said Dr. Hamilton. "Our objective was to examine the association between statin use and cancer outcomes in men undergoing surgery within the SEARCH database."

Reduced risk

The study, which was presented at the 2009 AUA annual meeting in Chicago, involved 1,325 men with prostate cancer treated by radical prostatectomy. Each patient's statin use at the time of surgery was ascertained by a review of medical records. Outcomes of interest included pathologic features of prostatectomy specimens and biochemical recurrence, which was defined in three ways: a single postoperative PSA value >0.2 ng/mL, two concentrations at 0.2 ng/mL, and secondary treatment for elevated postoperative PSA levels.

Analysis showed that 237 men (18%) were using statins at the time of surgery; 1,088 were not. In comparing the two groups, investigators found that statin users were older, had had surgery more recently, had lower PSA values, were more likely to be obese, and were more likely to have clinical stage T1c disease (67% vs. 58%, p=.009).

The only pathologic feature that distinguished statin users was a higher proportion of men with a Gleason sum of 7 (60% vs. 49%, p=.003).

In a multivariate analysis, statin use was associated with a 30% reduced risk for biochemical recurrence (hazard ratio=0.70) compared with nonusers (p=.03).

Dr. Hamilton acknowledged several limitations of the study, including its retrospective nature and lack of information on duration of statin use, postoperative statin use, statin dose, and patients' cholesterol levels.

Dr. Hamilton conducted the research in collaboration with Stephen J. Freedland, MD, of Duke University, and the SEARCH Database Study Group.