Statin Use and Risk of Prostate Cancer in the California Men's Health Study Cohort

Abstract

Statins have known anticarcinogenic effects, however, evidence for long-term statin use as effective chemoprevention for prostate cancer is inconsistent. We examined the association between statin use and risk of prostate cancer among 69,047 eligible participants in the California Men's Health Study, a prospective cohort of Northern and Southern California Kaiser Permanente (KP) members, ages 45 to 69 years, initiated in 2002. Prostate cancer cases were identified by linkage to the KP California Cancer Registries. Statin exposure, estimated from automated KP outpatient pharmacy records (available since 1991 in Southern California and since 1994 in Northern California), was treated as time-varying and defined as the cumulative days dispensed of any statin from the first dispensing until a prostate cancer diagnosis, radical prostatectomy, termination of membership, or end of study (December 31, 2004). Cox proportional hazards models with age as the time scale were used to estimate rate ratios, while controlling for confounding variables. During follow-up, 888 prostate cancer cases, including 131 advanced cases, were identified. There was no association between ever statin use or <5 years use and prostate cancer. Conversely, ≥5 years use was associated with a 28% lower risk for prostate cancer compared with nonuse (adjusted rate ratio, 0.72; 95% confidence interval, 0.53-0.99). This association did not differ markedly for advanced disease. However, the association did seem to be restricted to those who regularly take nonsteroidal anti-inflammatory drugs. Our findings suggest that long-term statin use might be associated with a reduced risk of prostate cancer but perhaps only among regular nonsteroidal anti-inflammatory drug users. (Cancer Epidemiol Biomarkers Prev 2007;16(11):2218–25)

Blood lipid levels and prostate cancer risk; a cohort study

“…4,[6][7][8] Supportive evidence for the potential role of cholesterol in prostate cancer development has been provided by observations that cholesterol-lowering drugs (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, commonly known as statins) might be inversely associated with risk of (advanced) prostate cancer. 4,[18][19][20][21] A meta-analysis by Bonovas et al 22 confirmed that use of statins lowers the risk of advanced prostate cancer (relative risk 0.77, 95% CI 0.64-0.93); however, no effect for total prostate cancer risk was found (relative risk 0.95, 95% CI 0.73-1.23). Others proposed that the cholesterol-lowering effects of statins might not be the only reason why these drugs are associated with reduced risk of advanced prostate cancer.…”

Epidemiologic Musing on Statin Drugs in the Prevention of Advanced Prostate Cancer

“…2), and a case-control study nested in the Finnish population (3), each investigating the association between use of statin drugs and prostate cancer. Along with work in the Health Professionals Follow-up Study reported last year by my colleagues and me (4), four prospectively conducted studies now support an inverse association between statin use and, specifically, advanced prostate cancer.…”

“…Participants in the CMHCS live in two regions of California, are multiethnic, and are members of a health maintenance organization. In 2002, 33% had ever been dispensed >100 days of a statin, and 19% of the men were considered to have used statins for 5+ years (2). In the Finnish study, all prostate cancer cases diagnosed in the country during 1995 to 2002 were included, and matched controls were sampled from the Population Register Center, apparently via incidence density sampling.…”

Clinical Potential of Statins in Prostate Cancer Radiation Therapy

“…However, the findings of the Shannon et al and Graaf et al studies (14,15) could not be replicated and a reduction in overall prostate cancer risk was not seen in four large, prospectively conducted trials (16)(17)(18)34). In three of these four studies, an inverse relationship with advanced prostate cancer was noted for either current or prior statin use, however an overall, decreased prostate cancer risk was not seen.…”