TY - JOUR
T1 - The Suggested Unique Association Between the Various Statin Subgroups and Prostate Cancer
AU - Goldberg, Hanan
AU - Mohsin, Faizan K.
AU - Saskin, Refik
AU - Kulkarni, Girish S.
AU - Berlin, Alejandro
AU - Kenk, Miran
AU - Wallis, Christopher J.D.
AU - Klaassen, Zachary
AU - Chandrasekar, Thenappan
AU - Ahmad, Ardalan E.
AU - Sayyid, Rashid K.
AU - Saarela, Olli
AU - Penn, Linda
AU - Alibhai, Shabbir M.H.
AU - Fleshner, Neil
N1 - Publisher Copyright:
© 2020 European Association of Urology
PY - 2021/5
Y1 - 2021/5
N2 - Background: The chemopreventive effect of various medications in prostate cancer (PCa) has gained interest. Specifically, the potential impact of statins on PCa incidence has been studied, but solely as a “drug family” overlooking the distinctive pharmacological properties of its two main subgroups: hydrophilic and hydrophobic statins. Objective: To assess the impact of statin subgroups on PCa-specific mortality (PCSM), PCa diagnosis, and undergoing another prostate biopsy. Design, setting, and participants: This is a population-based cohort study in Ontario identifying all men aged ≥66 yr with a history of a single negative prostate biopsy (representing healthy men at risk for PCa) between 1994 and 2016, who were not on any of the analyzed medications prior to the study, with a median follow-up of 9.42 yr (interquartile range 8.03 yr). Outcome measurements and statistical analysis: Using multivariable cause-specific hazard models with time-dependent covariates, the association of hydrophobic and hydrophilic statins with all study outcomes was analyzed. Other putative chemopreventive medications (including alpha-blockers, 5-alpha-reductase inhibitors, and proton-pump inhibitors), age, rurality, comorbidities, and study inclusion year were included in the models. Results and limitations: Overall, 21 512 men were identified. Statins were taken by 11 401 patients (50.3%), 5184 men (24.1%) were diagnosed with PCa, and 805 (3.7%) died from it. Overall, 7556 patients (35.1%) underwent another biopsy. Any use of hydrophilic statins was associated with a 32.4% (95% confidence interval [CI] 12.9–47.5%), a 20% (95% CI 10–28%), and an 18% (95% CI 6.1–27.3%) decreased risk of PCSM, undergoing another prostate biopsy, and being diagnosed with PCa, respectively. Hydrophobic statins were associated with 17% (95% CI 2–31%) decreased PCSM. The study is limited by its retrospective nature, selection bias, and accompanying health-administrative database inaccuracies. Conclusions: Use of any statin may be associated with a lower hazard of PCSM, with hydrophilic statins showing a greater association with decreased PCa diagnosis rates. Preferentially prescribing one statin subgroup over another in men needs further exploration. Patient summary: Use of any statin may be associated with a lower probability of dying from prostate cancer. Hydrophilic statins (rosuvastatin and pravastatin) may also be more positively associated with a lower risk of undergoing an additional prostate biopsy and being diagnosed with prostate cancer in men aged ≥66 yr.
AB - Background: The chemopreventive effect of various medications in prostate cancer (PCa) has gained interest. Specifically, the potential impact of statins on PCa incidence has been studied, but solely as a “drug family” overlooking the distinctive pharmacological properties of its two main subgroups: hydrophilic and hydrophobic statins. Objective: To assess the impact of statin subgroups on PCa-specific mortality (PCSM), PCa diagnosis, and undergoing another prostate biopsy. Design, setting, and participants: This is a population-based cohort study in Ontario identifying all men aged ≥66 yr with a history of a single negative prostate biopsy (representing healthy men at risk for PCa) between 1994 and 2016, who were not on any of the analyzed medications prior to the study, with a median follow-up of 9.42 yr (interquartile range 8.03 yr). Outcome measurements and statistical analysis: Using multivariable cause-specific hazard models with time-dependent covariates, the association of hydrophobic and hydrophilic statins with all study outcomes was analyzed. Other putative chemopreventive medications (including alpha-blockers, 5-alpha-reductase inhibitors, and proton-pump inhibitors), age, rurality, comorbidities, and study inclusion year were included in the models. Results and limitations: Overall, 21 512 men were identified. Statins were taken by 11 401 patients (50.3%), 5184 men (24.1%) were diagnosed with PCa, and 805 (3.7%) died from it. Overall, 7556 patients (35.1%) underwent another biopsy. Any use of hydrophilic statins was associated with a 32.4% (95% confidence interval [CI] 12.9–47.5%), a 20% (95% CI 10–28%), and an 18% (95% CI 6.1–27.3%) decreased risk of PCSM, undergoing another prostate biopsy, and being diagnosed with PCa, respectively. Hydrophobic statins were associated with 17% (95% CI 2–31%) decreased PCSM. The study is limited by its retrospective nature, selection bias, and accompanying health-administrative database inaccuracies. Conclusions: Use of any statin may be associated with a lower hazard of PCSM, with hydrophilic statins showing a greater association with decreased PCa diagnosis rates. Preferentially prescribing one statin subgroup over another in men needs further exploration. Patient summary: Use of any statin may be associated with a lower probability of dying from prostate cancer. Hydrophilic statins (rosuvastatin and pravastatin) may also be more positively associated with a lower risk of undergoing an additional prostate biopsy and being diagnosed with prostate cancer in men aged ≥66 yr.
KW - Hydrophilic statins
KW - Hydrophobic statins
KW - Prostate biopsy
KW - Prostate cancer
KW - Prostate cancer–specific survival
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U2 - 10.1016/j.euf.2020.06.005
DO - 10.1016/j.euf.2020.06.005
M3 - Article
C2 - 32620539
AN - SCOPUS:85087219627
SN - 2405-4569
VL - 7
SP - 537
EP - 545
JO - European Urology Focus
JF - European Urology Focus
IS - 3
ER -