"Interest in statins as a potential chemopreventive agent has grown, and there exist biological rationale, and laboratory and clinical data supporting our findings," the study team writes in European Urology.
Observational studies examining statin use and prostate-cancer risk have shown a modest but statistically significant overall risk reduction and a more clinically meaningful reduction in advanced or high-grade disease. But whether statin use at the time of primary treatment is associated with improved outcomes remains unclear, they point out.
To evaluate the association between statin use and outcomes, Dr. Robert Hamilton with Princess Margaret Cancer Center in Toronto, Canada, and colleagues did a post hoc secondary analysis of a randomized controlled trial of men initiating intermittent androgen deprivation (IAD) versus continuous ADT.
The 1,364 men in the trial had PSA levels greater than 3 ng/ml more than one year after primary/salvage radiotherapy. The 585 (43%) statin users were younger than non-statin users (72.7 vs. 73.8 years, P=0.001) and were less likely to have PSA above 15 ng/ml (20% vs. 25%, P=0.04).
After a median follow-up of 6.9 years, a total of 513 patients had died.
After adjusting for potential confounders, statin therapy was associated with a 36% reduction in the risk of death (hazard ratio, 0.64; 95% confidence interval, 0.53 to 0.78) and a 35% reduction in the risk of prostate-cancer-specific death (HR, 0.65; 95% CI, 0.48 to 0.87, P=0.004).
In addition, men on statin therapy had 13% longer time to castration resistance, although this did not reach statistical significance (P=0.15).
As an exploratory endpoint, the researchers examined whether statin use was associated with time off ADT among 681 men in the IAD group. They found that statin users in the IAD group had longer time off treatment (median: 0.85 vs. 0.64 years, P=0.06).
The authors say limitations of their study include the potential for residual confounding between statin users and nonusers, and confounding by indication.
Still, they conclude, "This study supports the benefit of statins in men on ADT. A prospective trial of statins in men commencing ADT is warranted."
Dr. Hamilton did not respond to a request for comment by press time.
The study had no commercial funding and the authors have no relevant disclosures.
SOURCE: https://bit.ly/2LtybBr European Urology, online December 31, 2020.
By Reuters Staff
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