Statin therapy after prostate cancer diagnosis reduces cancer mortality and all-cause mortality, according to a recent study, but even more benefit accrues from long-term use of these agents before a prostate cancer diagnosis.
In an article published in the Journal of Clinical Oncology, Yu et al report their analysis of data from 11,722 patients who were diagnosed with localized prostate cancer between 1998 and 2009.1 After a mean follow-up of 4.4 years, 1,791 subjects had died of prostate cancer and 3,499 had died of other causes. The prostate cancer mortality rate was 34.8 patients per 1,000 per year and all-cause mortality was 67.9 per 1,000 per year.
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Use of statins after diagnosis was associated with a 24% reduction in the risk of prostate cancer death. Longer duration of use and higher cumulative dose of statins were independently associated with further risk reduction: patients who took statins for 3 years or longer after prostate cancer diagnosis had 39% lower mortality and patients who were in the highest quartile of cumulative dose had 43% lower mortality compared with patients who did not take statins.
Statin use after prostate cancer diagnosis was also associated with a 14% reduction in overall mortality and a reduced risk of distant metastases
Greater Benefit from Early Use of Statins
Patients who took statins before being diagnosed with prostate cancer fared even better—they experienced a 45% reduction in the risk of prostate cancer mortality and a 34% reduction in the risk of overall mortality compared with patients who did not take statins. Again, longer duration of statin use and higher cumulative dose of statin conferred greater benefit.
In an accompanying editorial, Lorelei Mucci and Meir Stampfer call Yu’s research results “important new findings” with an “appropriate focus on the timing of statin use.”2
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The report by Yu et al adds to a growing body of evidence that statin therapy has beneficial effects on prostate cancer. Epidemiologic studies have shown that low serum cholesterol is associated with reduced risk of prostate cancer and that statin use is associated with reduced risk of advanced prostate cancer.3 Preclinical studies have shown that hypercholesterolemia accelerates growth of prostate tumors while reduction of serum cholesterol with hypocholesteremic agents induces tumor regression.
How statin use might reduce prostate cancer mortality is a subject of research. Mechanisms proposed to explain the effect of lower cholesterol on prostate cancer progression include reduced cell proliferation and inflammation, disruption of membrane organization, and reduced synthesis of androgens.3
Should Clinical Practice Change?
The clinical implications of this and other studies on the effect of statin use on prostate cancer outcomes are far from clear. In this study, the greatest benefit from statins was derived from prediagnostic use, but as Mucci and Stampfer point out, there is not enough evidence to recommend these agents prophylactically. In fact, there may never be, because primary prevention trials would be too expensive. For now, they suggest, the evidence might justify prescribing a statin for men who are on the border of needing cardiovascular risk reduction with the hope of reducing prostate cancer risk as well.
- Yu O, Eberg M, Benayoun S, et al. Use of statins and the risk of death in patients with prostate cancer. J Clin Oncol. 2014;32(1):5-11.
- Mucci LA, Stampfer MJ. Mounting evidence for prediagnostic use of statins in reducing risk of lethal prostate cancer. J Clin Oncol. 2014;32(1):1-2.
- Pelton K, Freeman MR, Solomon KR. Cholesterol and prostate cancer. Curr Opin Pharmacol. 2012;12(6):751–759.