他汀类药物使用与前列腺癌筛查、前列腺体积、高级别前列腺上皮内瘤变（PIN）和前列腺癌之间的关联。
The associations between statin use and prostate cancer screening, prostate size, high-grade prostatic intraepithelial neoplasia (PIN), and prostate cancer.
机构信息
Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave. 6th Floor, Suite 600, Nashville, TN 37203-1738, USA.
出版信息
Cancer Causes Control. 2011 Mar;22(3):417-26. doi: 10.1007/s10552-010-9713-4. Epub 2010 Dec 19.
OBJECTIVE
Prior studies report statins may reduce the risk of advanced prostate cancer. This study investigates the association between statin use and the likelihood of having a PSA or DRE test, blood PSA levels, prostate volume, and the severity of lower urinary tract symptoms. We also describe the association between statin use and prostate cancer and high-grade prostatic intraepithelial neoplasia (PIN) before and after controlling for prostate cancer screening indices associated with statin use.
METHODS
The Nashville Men's Health Study used a multicenter, rapid recruitment protocol to collect clinical, biologic, behavioral, and body measurement data from 2,148 men 40 years or older scheduled for diagnostic prostate biopsy. Medication use and other data were ascertained by research survey, clinical interview, and chart review.
RESULTS
Approximately 37% of participants were taking a statin. Statin use was significantly associated with a 12% lower PSA levels and 8% smaller prostate volume after controlling for age, race, BMI, WHR, aspirin use, and other comorbidity. Simvastatin was more strongly associated with prostate volume, while atorvastatin was associated with PSA. Statin use was marginally associated with increasing PSA test frequency among men with undiagnosed cancer. Statin use was not associated with the frequency or results of digital rectal exams, lower urinary tract symptom severity, high-grade (Gleason > 6) prostate cancer (OR = 0.95 (0.73, 1.24)), low-grade (Gleason = 6) prostate cancer (OR = 1.11 (0.86, 1.42)) or PIN (OR = 0.82, (0.57, 1.17)). Additional control for the number of prior PSA tests, PSA levels, and prostate volume did not alter these results.
CONCLUSION
These results suggest selective referral for biopsy associated with statin use is an essential element to address in further understanding the potential for statins to prevent prostate cancer.
目的
先前的研究报告称他汀类药物可能降低晚期前列腺癌的风险。本研究调查了他汀类药物使用与 PSA 或 DRE 检测、血 PSA 水平、前列腺体积以及下尿路症状严重程度之间的关联。我们还描述了在控制与他汀类药物使用相关的前列腺癌筛查指标后，他汀类药物使用与前列腺癌和高级别前列腺上皮内瘤变（PIN）之间的关联。
方法
纳什维尔男性健康研究采用多中心快速招募方案，从 2148 名年龄在 40 岁或以上、计划进行诊断性前列腺活检的男性中收集临床、生物学、行为和身体测量数据。药物使用和其他数据通过研究调查、临床访谈和病历审查确定。
结果
约 37%的参与者正在服用他汀类药物。在控制年龄、种族、BMI、WHR、阿司匹林使用和其他合并症后，他汀类药物使用与 PSA 水平降低 12%和前列腺体积缩小 8%显著相关。辛伐他汀与前列腺体积的相关性更强，而阿托伐他汀与 PSA 相关。他汀类药物使用与未诊断出癌症的男性中 PSA 检测频率的增加呈边缘相关。他汀类药物使用与数字直肠检查的频率或结果、下尿路症状严重程度、高级别（Gleason>6）前列腺癌（OR=0.95（0.73，1.24））、低级别（Gleason=6）前列腺癌（OR=1.11（0.86，1.42））或 PIN（OR=0.82，（0.57，1.17））无关。进一步控制先前 PSA 检测次数、PSA 水平和前列腺体积并没有改变这些结果。
结论
这些结果表明，与他汀类药物使用相关的选择性活检转诊是进一步了解他汀类药物预防前列腺癌潜力的一个重要方面。
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