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May 14, 2014
Initiating Statin Therapy After Prostate Cancer Surgery Reduces Recurrence

Durham, NC—Patients should be prescribed statins after prostate cancer surgery, according to the authors of a new retrospective analysis that finds men who begin taking the cholesterol-lowering drugs after radical prostatectomy are less likely to have a recurrence of their cancer.

“Our findings suggest that beginning statins after surgery may reduce the risk of prostate cancer recurrence, so it’s not too late to start statins after a diagnosis,” said lead author Emma H. Allott, PhD, a postdoctoral associate in the Division of Urology at Duke University School of Medicine and the Durham, North Carolina, Veterans Affairs Medical Center.

A secondary analysis of the research, published online by BJU International (formerly the British Journal of Urology), indicated that the protective association was only significant among nonblack men, and authors call for further investigation of the possible racial disparity.

For men with localized prostate cancer, radical prostatectomy is a common treatment option, but about 30% of men have a recurrence of their prostate cancer within 10 years of surgery, according to study background.

In previous meta-analyses examining the effect of statins on prostate cancer risk and progression, the results have been mixed. In some lab studies of cells and tissue samples, cholesterol has been shown to promote prostate cancer growth, while in others, lowering cholesterol appears to slow prostate cancer growth and reduce inflammation, according to the report.

“It is possible that statins could inhibit cancer growth through several mechanisms, either directly by inhibiting certain metabolic pathways, or indirectly by lowering cholesterol,” said senior author Stephen J. Freedland, MD, associate professor of urology and pathology at Duke and a urologist at the Durham Veterans Affairs Medical Center. “Given how widely-prescribed statins are, and the biological plausibility of statins slowing cancer growth, it is important for us to figure out how they may affect men with prostate cancer.”

The researchers analyzed the medical records of 1,146 patients within the Shared Equal Access Regional Cancer Hospital (SEARCH) database who underwent radical prostatectomy for prostate cancer. Men who had never used statins prior to surgery were specifically selected so that researchers could test whether beginning statin therapy after primary treatment could influence prostate cancer progression. The authors note that the results are important for translating findings to randomized controlled trials and eventually to change clinical practice.

During a median follow-up period of just more than 6 years, cancer returned in 65 of the 400 men who began taking statins after surgery and in 337 of 746 men who never took statins. Based on statistical analysis taking into account the demographic and tumor characteristics of patients in addition to the duration of statin use during the follow-up period, the researchers were able to conclude that postoperative statin use was associated with a 36% reduced risk of prostate cancer recurrence.

While prior studies have shown race-specific differences in prostate cancer tumor biology, the authors recommend additional research to determine why the protective association was not significant among black men.

In addition, since the current study was retrospective, the researchers emphasize the importance of conducting randomized, controlled trials to assess the effect of postoperative statin use on prostate cancer recurrence.

“These future studies will help to determine whether statins—which are cost-effective and generally well-tolerated—may play a beneficial role in prostate cancer treatment, in addition to their proven role in preventing cardiovascular mortality,” Allott said.





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