Prostate Cancer Mortality Lower in Statin Users
ASCO GU: Prostate Cancer Mortality Lower in Statin Users
By Charles Bankhead, Staff Writer, MedPage Today
Published: February 27, 2009
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
ORLANDO, Feb. 27 -- Prostate cancer mortality risk declined by 50% in men taking statins for reasons unrelated to cancer, data from a case-control study showed.
The mortality benefit increased to almost two-thirds after adjustment for potential confounding factors, according to Stephen Marcella, M.D., of the University of Medicine and Dentistry of New Jersey School of Public Health in Piscataway. He reported his findings at the Genitourinary Cancers Symposium here.
The benefit was greatest in men taking high-potency statins, such as atorvastatin (Lipitor) and rosuvastatin (Crestor), as well as lipophilic statins, such as atorvastatin and fluvastatin (Lescol).
"The strongest feature of this study is that it looks at mortality," said Dr. Marcella. "A few other studies have looked at advanced prostate cancer, and they are accumulating. We actually looked at prostate cancer death, and we verified in every case that the patient died of prostate cancer." Action Points
Explain to patients that this study showed a 50% lower risk of prostate cancer mortality in men who had history of treatment with statin drugs.
Note that the findings came from a retrospective review of databases, not a controlled clinical trial, and therefore cannot prove that statins reduce the risk prostate cancer death.
Note that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Several recent studies have suggested that statin exposure decreases the risk of advanced or metastatic prostate cancer. Evidence also has linked prostate cancer to obesity and metabolic syndrome, two indications for statin use.
Any protective effect of statins in prostate cancer might be underestimated without adjustment for potential confounding by obesity, metabolic syndrome, and other factors, said Dr. Marcella.
To examine the effect of incidental statin use on prostate cancer mortality, investigators examined data from the New Jersey Cancer Registry. Patients who died of prostate cancer during 1999 to 2001 were identified and compared with matched controls randomly selected from a Medicare database.
The study involved 380 cases and 380 controls, all of whom were married during the period reviewed, a requirement to obtain access to deceased patients' medical records. Patients were matched with respect to age, race, education, and comorbid conditions. The mean age of the entire study population was about 66 years.
Investigators abstracted data on height and weight, medication use, and history of serious or chronic illness. Patients and controls were compared with respect to statin exposure from 1989 forward. Prespecified analyses included effects of high- versus low-potency statins and hydrophilic versus lipophilic statins.
The cases and controls differed substantially with respect to medication use. Significantly more patients in the control group had a history of statin use (71.2% versus 16.6%, P<0.0001), whereas significantly more prostate cancer patients had received antihypertensive therapy (75.7% versus 53%, P<0.0001) and other types of cardiac medications (41.7% versus 28%, P<0.0001).
Unadjusted results revealed a prostate cancer mortality odds ratio of 0.49 for statin users versus nonusers (P<0.0001). Adjustment for demographic and clinical variables, including use of antihypertensive medications, further reduced the odds ratio to 0.37 (P<0.0001).
Analysis by type of statin showed the following prostate cancer mortality odds ratios:
Hydrophilic statin, 0.41, P=0.02
Lipophilic statin, 0.35, P=0.0002
High-potency statin, 0.27, P<0.0001
Low-potency statin, 0.69, P=0.32
The study was supported by the National Cancer Institute.
Dr. Marcella reported no disclosures.
Primary source: ASCO: Genitourinary Cancers Symposium
Marcella S, Rhoads G "Statin use and death from prostate cancer: a statewide population-based study" ASCO: GU 2009; Abstract 26.