Use of Aspirin and Other Nonsteroidal Antiinflammatory Medications in Relation to Prostate Cancer Risk

Claudia A. Salinas; Erika M. Kwon; Liesel M. FitzGerald; Ziding Feng; Peter S. Nelson; Elaine A. Ostrander; Ulrike Peters; Janet L. Stanford

Disclosures

Am J Epidemiol. 2010;172(5):578-590. 

In This Article

Abstract and Introduction

Abstract

Recent interest has focused on the role that inflammation may play in the development of prostate cancer and whether use of aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs) affects risk. In a population-based case-control study designed to investigate the relation between these medications and prostate cancer risk, detailed exposure data were analyzed from 1,001 cases diagnosed with prostate cancer between January 1, 2002, and December 31, 2005, and 942 age-matched controls from King County, Washington. A significant 21% reduction in the risk of prostate cancer was observed among current users of aspirin compared with nonusers (95% confidence interval (CI): 0.65, 0.96). Long-term use of aspirin (>5 years: odds ratio = 0.76, 95% CI: 0.61, 0.96) and daily use of low-dose aspirin (odds ratio = 0.71, 95% CI: 0.56, 0.90) were also associated with decreased risk. There was no evidence that the association with aspirin use varied by disease aggressiveness, but there was effect modification (P interaction = 0.02) with a genetic variant in prostaglandin-endoperoxide synthase 2 (PTGS2) (rs12042763). Prostate cancer risk was not related to use of either nonaspirin NSAIDs or acetaminophen. These results contribute further evidence that aspirin may have chemopreventive activity against prostate cancer and highlight the need for additional research.

Introduction

Prostate cancer is the most frequent noncutaneous cancer in men,[1] and discovery of modifiable determinants of risk could present an opportunity to prevent or delay the onset of this common disease. Established risk factors such as ancestry or family history are not modifiable, and the evidence for dietary and lifestyle risk factors is inconclusive.[2] However, in recent years the role of inflammation in cancer etiology has gained attention, and several studies have suggested that nonsteroidal antiinflammatory drugs (NSAIDs) may have chemopreventive activity.[3] Use of NSAIDs has been associated with a reduced risk of prostate cancer in some, but not all, studies.[4] Eight studies that evaluated aspirin use and prostate cancer reported 15%–55% reductions in risk,[5–12] 2 studies found increases in risk,[13,14] and 5 reported no association.[15–19]

Given the potential role of the inflammation pathway in the development of prostate cancer, a population-based case-control study was conducted to evaluate the effects of aspirin and other NSAID use on prostate cancer risk. The relation between use of these medications and clinical characteristics of prostate cancer was also explored. In addition, genetic variants in 2 cyclooxygenase genes (PTGS1, PTGS2) that may alter aspirin effects were examined.

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