Statins Don't Cut Prostate Cancer Recurrence After Prostatectomy

[JimJimJimJim]

Jim Marshall (not a doctor) said ...

When talking about an earlier study that reported that statins may delay the onset of prostate cancer we said:

This is not the sort of evidence that would lead your doctor to give you a statin to slow your cancer, but if your doctor has already prescribed a statin, this result should give you a warmish feeling that the statin may also be fighting your cancer.

The study quoted below found that after prostate removal surgery statins had no effect on keeping the cancer from coming back, and the authors give stronger advice to your doctor:

"There is now accumulated evidence that statin use does not influence prostate cancer progression after radical prostatectomy," Dr. Bonovas concluded. "Physicians need to be vigilant in ensuring that the use of statins remains restricted to the approved cardiovascular indications."

So, if you doctor gives you statins to help keep the blood flowing strongly through you - fine.

But, no use in giving it you just in the hope of delaying recurrence of your cancer.

One particular statin, Lipitor (Atorvastatin), became the most prescribed drug in history in 2003.

Statins include: Lipitor (atorvastatin), Lescol (fluvastatin), Mevacor (lovastatin), Altoprev (lovastatin extended-release), Livalo (pitavastatin), Pravachol (pravastatin), Crestor (rosuvastatin), and Zocor (simvastatin). Combination products include: Advicor (lovastatin/niacin extended-release), Simcor (simvastatin/niacin extended-release), and Vytorin (simvastatin/ezetimibe)

... end Jim

From Reuters Health Information

Statins Don't Cut Prostate Cancer Recurrence After Prostatectomy

By Will Boggs, MD

NEW YORK (Reuters Health) Aug 01 - Statin users did not have a lower rate of biochemical recurrence after radical prostatectomy in a recent study.

"Prostate cancer can be a very aggressive disease, and we are all looking for a golden bullet to stop it in its tracks," Dr. Alon Y. Mass from New York University School of Medicine in New York City told Reuters Health by email. "We entered this study being hopeful that we may be able to isolate a viable therapy to combat the progression of prostate cancer after prostatectomy. Unfortunately, statins don't seem to be the answer."

Previous studies investigating the effect of statins on prostate cancer incidence and progression have yielded inconsistent results, although a 2008 meta-analysis by Bonovas et al demonstrated a 23% risk reduction for advanced high grade/metastatic prostate cancer with statin treatment.

The cohort studied by Dr. Mass and colleagues consisted of 1,446 men who had radical prostatectomy, including 437 (30.2%) who said reported being on statins at the time of surgery. The median for follow-up was 57 months.

Overall biochemical recurrence-free survival rates did not differ significantly for statin users vs nonusers (87.4% vs 89.0%; p=0.26). Moreover, there was no difference in biochemical recurrence-free survival between subgroups of users and nonusers with low and intermediate-high risk disease.

The lack of an effect of statins on survival persisted after adjustment for other risk factors, the researchers reported online July 20th in The Journal of Urology.

"Our study and meta-analysis indicated no association between statin use and biochemical recurrence," the researchers conclude. "However, the only way to definitely determine whether statins influence prostate cancer progression is to perform a randomized, double-blind study in men at high risk for prostate cancer progression after open radical retropubic prostatectomy."

But, Dr. Mass said, "Since a large proportion of patients are already on statin therapy, even if a prospective trial were warranted, the number of patients needed to enroll in such a study to make it powerful enough to reach significance would be immense. Thus, we need to find more reasonable methods in assessing statin therapy and other medications in relation to prostate cancer growth and biochemical recurrence."

Dr. Stefanos Bonovas from the University of Athens, Greece, who led the 2008 meta-analysis, told Reuters Health by email, "The (new) findings, along with the meta-analysis results, are quite convincing that preoperative statin use does not affect the risk of biochemical recurrence after radical prostatectomy. Furthermore, the results are in line with recent large meta-analyses, which demonstrated that statins do not cause any substantial change in risk of prostate or other site-specific cancers."

"There is now accumulated evidence that statin use does not influence prostate cancer progression after radical prostatectomy," Dr. Bonovas concluded. "Physicians need to be vigilant in ensuring that the use of statins remains restricted to the approved cardiovascular indications."

As an aside, Dr. Mass added that statins are known to lead to lower serum levels of prostate specific antigen levels -- up to 30% lower after five years of use. "This effect is magnified if the patient is on other medications, such as NSAIDS or thiazides," he said. "So the standard biopsy threshold value of 4.0 ng/mL could be meaningless in a patient who is on many medications."

"By creating a new threshold value," Dr. Mass said, "we can hopefully limit the amount of false negatives. In addition, the emergence of new biomarkers may act synergistically with the PSA test or may one day supplant this test altogether - it will be interesting to see how statin therapy (and other medications) affect these emerging assays."

SOURCE: http://bit.ly/NU76Qm

J Urol 2012;188:786-791.