Prostate Cancer Risk in Men with Baseline History of Coronary Artery Disease: Results from the REDUCE Study

Abstract

Background: Coronary artery disease (CAD) and prostate cancer (PCa) are not only common diseases, but share many risk factors. To date, only a few studies have explored the relationship between CAD and PCa risk, with conflicting results.Methods: The four-year REDUCE study tested dutasteride 0.5 mg daily for PCa risk reduction in men with prostate specific antigen (PSA) of 2.5 to 10.0 ng/mL and a negative biopsy. Among men who underwent at least one on-study biopsy (n ¼ 6,729; 82.8%), the association between CAD and overall PCa risk and disease grade was examined with logistic and multinomial logistic regression adjusting for clinicopathologic features, respectively.Results: Overall, 547 men (8.6%) had a history of CAD. Men with CAD were significantly older and had higher body mass index, PSA, and larger prostate volumes and were more likely to have diabetes, hypertension, and hypercholesterolemia and take aspirin and statins. On multivariate analysis, CAD was associated with a 35% increased risk of PCa diagnosis (OR ¼ 1.35, 95% CI: 1.08-1.67, P ¼ 0.007), while elevating risk of both low-(OR ¼ 1.34, 95% CI: 1.05-1.73, P ¼ 0.02) and high-grade disease (OR ¼ 1.34, 95% CI: 0.95-1.88, P ¼ 0.09).Conclusions: In a post hoc hypothesis developing secondary analysis of the REDUCE study, CAD was significantly associated with increased PCa diagnosis.Impact: If confirmed in other studies, this suggests CAD may be a novel PCa risk factor and suggests common shared etiologies. Whether lifestyle changes shown to reduce CAD risk (i.e., weight loss, exercise, cholesterol reduction, etc.) can reduce PCa risk, warrants further study. Cancer Epidemiol Biomarkers Prev; 21(4); 576-81. Ó2012 AACR.

Obesity, Diabetes Mellitus and Vascular Disease: A Complex Relationship with Prostate Cancer

“…In REDUCE study vascular disease was associated with an increased risk of PCa diagnosis (OR = 1.35) [32]. Our findings also are consistent with autopsy study of Stamatiou suggesting that men with PCa had greater advanced atheromatosis than subjects without PCa [30].…”

“…Nevertheless, only a few studies have explored the relationship between vascular disease and PCa risk, with inconclusive results [14]- [18].…”

Lipoproteins and Cancer

“…In a case-control study in 1294 Italian men <75 years of age with incident PrC compared to 1451 men hospitalized with acute, non-neoplastic conditions, the odd ratio (OR) for prostate cancer was 1.54 (95% CI, 1.26-1.89) for those with hypercholesterolemia (Pelucchi, Serraino et al 2011). A post hoc analysis of the REDUCE study (which evaluated the anti-testosterone dutasteride in men with high prostate specific antigen (PSA) values but no PrC) examined the association of coronary artery disease (CAD) with PrC risk (Thomas, Gerber et al 2012). In 6729 men who underwent at least one biopsy, those with CAD had an increased risk of PrC diagnosis (OR = 1.35, 95% CI, 1.08-1.67), suggesting common risk factors.…”

Association between Types of Chronic Conditions and Cancer Stage at Diagnosis among Elderly Medicare Beneficiaries with Prostate Cancer

“…For example, the presence of cardiovascular disease may increase the risk of prostate cancer as it shares common risk factors for the development of aggressive prostate cancer, such as the presence of high cholesterol level and obesity. 9,10 Few studies have investigated the relationship between specific types of chronic conditions and cancer stage at diagnosis. Findings from these studies suggest that the association between preexisting chronic conditions and cancer stage at diagnosis depends on the types of chronic conditions.…”

“…[11][12][13] With respect to mental health conditions, a retrospective study found that elderly men with depression were not more likely to be diagnosed with a higher grade of prostate cancer compared to those without depression. 9 Although these studies have highlighted the relationship between specific chronic conditions and cancer stage at diagnosis, many of these studies are outdated, single-institution database studies and suffer from the risk of detection bias because screening for prostate cancer was not included as one of the independent variables. [5][6][7] Furthermore, none of these studies examined the association between types of chronic condition combinations and cancer stage at diagnosis among elderly men.…”