Aspirin and Reduced Risk of Dying From Prostate Cancer

Roxanne Nelson, BSN, RN

January 05, 2016

In men with prostate cancer, regular aspirin use is associated with a slower rate of disease progression and a reduced risk of dying from the disease, according to a new study.

The findings come from an analysis of data from the large prospective Physicians' Health Study, in which 3193 men developed prostate cancer over a 27-year period. Of these cancers, 403 were lethal, defined as metastatic disease or death from prostate cancer.

But the risk developing lethal prostate cancer was 24% lower in men who took aspirin on a regular basis, explained lead investigator Christopher Brian Allard, MD, a urologic oncology fellow at Brigham and Women's Hospital and Massachusetts General Hospital in Boston.

Dr Allard was speaking at a press briefing held in advance of the Genitourinary Cancers Symposium 2016 in San Francisco.

"Men with prostate cancer who took aspirin regularly had a 39% lower risk of dying from prostate cancer," said Dr Allard.

However, aspirin use did not measurably reduce the overall incidence of prostate cancer. It also did not prevent high-grade cancers or locally advanced prostate cancers, Dr Allard noted.

"We found that aspirin intake before prostate cancer diagnosis was not beneficial," he reported.

Several observational studies that have looked at the association between aspirin use and prostate cancer outcomes have produced mixed results. For example, a large population-based study conducted last year in the United Kingdom showed that aspirin use after newly diagnosed nonmetastatic prostate cancer does not lower disease-specific or overall mortality.

However, an earlier study showed that anticoagulants reduced the risk of dying from the disease from 10% to 4% at 10 years, and that the benefit was greatest with aspirin use.

Details of Current Study

In their analysis, Dr Allard and his colleagues evaluated 22,071 male physicians who were followed from 1982 to 2009. The team assessed the relation between regular aspirin intake (at least three tablets per week) and lethal prostate cancer.

"We also evaluated whether the regular aspirin intake decreased the risk of overall prostate cancer and high-risk prostate cancer," Dr Allard explained.

Secondary outcomes included the incidence of total, high-grade (Gleason 8 to 10), and advanced (T3b to T4 or N1 or M1) cancers.

Regular aspirin use decreased the multivariate-adjusted risk for lethal prostate cancer (hazard ratio [HR], 0.67). In addition, regular use for a 12-month period was protective, although the effects diminished with time since last regular use (P for trend = .007).

Regular aspirin use after the diagnosis of prostate cancer was associated with a decrease in prostate cancer mortality (HR, 0.79), but was not significantly associated with the incidence of total, high-grade, or advanced cancers.

"Our study demonstrates that regular aspirin intake may inhibit lethal prostate cancer, probably by preventing cancer progression," Dr Allard concluded. "More work is needed to identify particular subsets of men most likely to benefit from aspirin and to determine regular aspirin dose."

Caution Needed and Other Steps to Take

This work suggests that aspirin is linked to a lower risk of dying from prostate cancer, said briefing moderator Sumanta Pal, MD, who is a spokesperson for the American Society of Clinical Oncology.

 
While it is provocative, it is an observational study.
 

"But while it is provocative, it is an observational study," Dr Pal pointed out. "These studies are thought-provoking, but are best followed by clinical trials, where we can compare the use of aspirin with no treatment or perhaps a placebo."

But questions remain. "For instance, we don't know the right dose or which patients will derive the most benefit," Dr Pal said. "It is also critical to keep in mind that aspirin can have some severe consequences, such as bleeding."

Men diagnosed with prostate cancer who fail potentially curative treatment always ask if there is anything they can do, said James L. Mohler, MD, associate director for translational research and chair of Department of Urology at the Roswell Park Cancer Institute in Buffalo, New York.

"I always recommend rest, exercise, less stress, more leafy green vegetables and fruit, and less red meat," he told Medscape Medical News. "Excellent data support my recommendation of lycopene and genistein found in tomatoes and soy to men who wish to do more."

He also suggests a baby aspirin daily, which is probably good for the cardiovascular system anyway. "Small changes in the prostate cancer growth rate or metastatic potential can translate into long extensions in survival since prostate cancer grows relatively slowly, compared with most other cancers," Dr Mohler said.

This study was funded by the Prostate Cancer Foundation and the National Institutes of Health/National Cancer Institute. The authors have disclosed no relevant financial relationships. Dr Pal reports receiving honoraria from Astellas, Pharma, Medivation, and Novartis; serving in a consulting/advisory role with AVEO, Genentech, Myriad Pharmaceuticals, Novartis, and Pfizer; and receiving research funding from Medivation.

Genitourinary Cancers Symposium (GUCS) 2016: Abstract 306. To be presented January 7, 2016.

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