AUA 2009: Statin Use Cuts Risk for Biochemical Recurrence After Radical Prostatectomy

Martha Kerr

April 28, 2009

April 28, 2009 (Chicago, Illinois) — Men with prostate cancer who undergo radical prostatectomy and who are concurrently taking statin therapy have a 30% lower risk for biochemical recurrence, shown by an increase in prostate-specific antigen (PSA) levels after surgery, than their counterparts who are not taking statin medication, according to results from a study of the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

Findings from SEARCH were presented here at the American Urological Association 104th Annual Scientific Meeting by lead investigator Robert J. Hamilton, MD, from the University of Toronto in Ontario, who conducted the study while he was a research fellow in the Department of Surgery, Division of Urology, at Duke University School of Medicine in Durham, North Carolina.

The study involved 1325 men in the SEARCH database who underwent radical prostatectomy. Of the cohort, 237 men (18%) were taking statin therapy at the time of surgery and 1088 (82%) were not.

Statin users were on average 2.0 years older (P < .001) and had undergone radical prostatectomy more recently; the median year of surgery was 2004 for users and 2002 for nonusers. Statin users were diagnosed at lower clinical stages, with 67% of users and 58% of nonusers diagnosed with T1 disease (P = .009). PSA levels were lower among users (6.2 ng/mL) than among nonusers (6.2 ng/mL; P = .04).

Statin users tended to have higher biopsy Gleason scores at baseline, with 50% of statin users and 38% of nonusers having a Gleason score of 7 or higher (P = .001).

"After adjustment for multiple clinical and pathological factors, statin use was associated with a 30% lower risk of PSA recurrence" in the approximately 5 years since surgery" (hazard ratio, 0.70; 95% confidence interval, 0.50 - 0.97; P = .03), Dr. Hamilton told meeting attendees. Biochemical recurrence was defined as an increase in PSA level of 0.2 ng/mL or more.

"Statins don't appear to reduce the risk of prostate cancer overall, but they do appear to be associated with a reduced risk of advanced aggressive cancers," he told Medscape Urology after his presentation. He said previous studies have shown that statins inhibit cancer-cell growth.

"Statins also appear to improve outcome after radiation treatment for prostate cancer," he added.

The benefit of statin therapy could be attributable to a reduction in inflammation, to their lipid-lowering effect, or to their effect on androgens or some other cell pathway, he speculated.

"Despite statin users having higher Gleason scores at baseline, older age, and more advanced disease at diagnosis, the risk of biochemical recurrence was lower in the years after surgery than for nonusers," Dr. Hamilton pointed out. "Those on statins the longest showed the greatest benefit.

"It is important to note that there were likely comorbidities not captured in our database that could have influenced our findings, but if anything, those on statins would be sicker than those who were not . . . yet they had a lower risk of biochemical recurrence," Dr. Hamilton said.

"This study had limitations. It was not a randomized trial, it had a short duration, and the type and dose of statin were not controlled for. The next step is a randomized controlled trial of statins after surgery," he said.

"Here we have proof of concept," J. Brantley Thrasher, MD, professor and chair of the Department of Urology at the University of Kansas School of Medicine in Kansas City, Kansas, told Medscape Urology.

"From here forward, we have to put more emphasis on well-designed clinical trials. . . . These will need to be at least 10 to 15 years in duration . . . before we know whether statins should be prescribed for prevention of prostate cancer recurrence."

Dr. Hamilton and Dr. Thrasher have disclosed no relevant financial relationships.

American Urological Association 104th Annual Scientific Meeting: Abstract 1598. Presented April 27, 2009.

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