Low-dose aspirin and survival in men with prostate cancer: a study using the UK Clinical Practice Research Datalink

Abstract

We found no evidence of an association between low-dose aspirin use before or after diagnosis and risk of prostate cancer-specific mortality, after potential confounders were accounted for, in UK prostate cancer patients.

The Use of Aspirin and the Risk of Mortality in Patients with Prostate Cancer

“…The latter findings are consistent with those of 3 observational studies that reported null associations with pre-diagnostic use of aspirin on prostate cancer mortality. 6,7,9 Taken together, these results argue against a protective association between the use of aspirin and the risk of prostate cancer mortality and all cause mortality. In light of a recent study reporting decreased prostate cancer mortality among high risk patients (HR 0.60 95% CI 0.37e0.99), 9 we performed a similar analysis but were not able to replicate these findings (HR 1.85 95% CI 1.51e2.30).…”

“…3 In contrast, the 2 other postdiagnostic studies reported null associations with point estimates close to the null value. 2,7 Several of the aforementioned observational studies had methodological shortcomings which may explain their discrepant results. Specifically, immortal time bias was present in 3 studies, 2,3,10 a bias that is the result of misclassifying unexposed person-time as exposed person-time in cohort studies.…”

“…2e9 Indeed, in some studies the use of aspirin was associated with strong risk reductions in prostate cancer mortality ranging between 39% to 57%, 3,5,6,8 while others reported null findings. 2,7,9 Despite these inconsistent results, several have advocated the launch of aspirin randomized controlled trials in patients with prostate cancer. 3,6 However, several of the aforementioned studies had important methodological shortcomings.…”

Effect of aspirin and other non-steroidal anti-inflammatory drugs on prostate cancer incidence and mortality: a systematic review and meta-analysis

“…The studies that met the inclusion criteria were all observational studies, comprising 20 case–control [9-11,16,17,21-23,26,28-33,35-37,41],[44] and 19 cohort studies [7,8,12-15,18-20,24,25,27,34],[39,40,42,43,45,46] involving more than 924,502 male subjects, including 108,136 PCa cases. Thirty-one studies (18 case–control [9-11,16,17,21-23,26,28-33,35-37] and 13 cohort [7,8,12-15,18-20,24,25,27,34]) addressed the use of any NSAID and its association with PCa incidence risk (Table 1); eight studies (two case–control [41,44] and six cohort [39,40,42,43,45,46]) investigated whether NSAID use was associated with PCa-specific mortality (Table 2).…”

Dissecting the Dual Role of AMPK in Cancer: From Experimental to Human Studies

“…This group also found that aspirin use among patients with non-metastatic adenocarcinoma at diagnosis was associated with a reduced risk of subsequent metastasis (summary RR=0.45; 95% CI: 0.28–0.72) and cancer death (summary RR=0.50; 95% CI: 0.34–0.74) among 5 randomized trials of daily aspirin for the prevention of vascular events (130). Additional observational studies support an association between regular aspirin use after diagnosis and improved survival outcomes among breast (131, 132), colorectal [(133–137), reviewed in (138)], and prostate cancer (139, 140) patients, while other studies do not (141–144). Overall, the current evidence from long-term observational and randomized studies is strongly suggestive of a potential role for aspirin in the primary and secondary prevention of cancer.…”