Khosropanah Iradj, Falahatkar Siavash, Farhat Babak, Heidari Bateni Zhoobin, Enshaei Ahmad, Allahkhah Ali Akbar, Khosropanah Darya
Urology Research Center, Guilan University of Medical Sciences, Guilan, Iran.
Acta Med Iran. 2011;49(12):789-94.
The previous large retrospective studies demonstrated that treatment with Statins reduces both the incidence of prostate cancer by 50% and serum Prostate Specific Antigen (PSA) level up to 40%. However the main problem in those studies was the absence of control groups of men with hypercholesterolemia without Statin treatment. We performed a small prospective controlled clinical trial to assess the influence of the treatment with Atorvastatin on serum PSA in men with hypercholesterolemia referred to our educational and treatment center from October 2007 to March 2008. In this study, among the newly diagnosed males with hypercholesterolemia (LDL > 130 mg/dl), 40 patients with LDL more than 190 mg/dl were selected as a case group and were treated with Atorvastatin (20 mg/day). Among the same population and in the same period, another 40 patients with LDL between 130 and 190 mg/dl were selected as first control group and were treated only with low fat diet. Another 40 patients with normal serum cholesterol and without any treatment were selected as second control group. The lipid profile and serum PSA level of patients of all groups were tested at the first and third months after the therapy. After completion of data, the mean serum lipids and PSA level were measured in both visits and compared with each other by paired t-test. Also the mean PSA change in two visits between three groups was compared by ANOVA and Tukey HSD test. There was not any significant difference in mean baseline PSA between hypercholesterolemic and normocholesterolemic patients (P=0.547). In case group, mean PSA and LDL was reduced by 14.1% (P=0.0001) and 30% (P=0.0001) respectively by second visit. In first control group, mean PSA was not changed significantly (P=0.337), whereas mean LDL in this group was reduced by 9.6% (P= 0.0001). Similarly in the second control group mean PSA was not changed significantly (P=0.309) by second visit. In addition, mean change of PSA in case group was compared with first and second control groups that was significantly different (P=0.0001) whereas mean change of PSA between two control groups was not significantly different (P=0.615). The results of this study showed that: 1) Short term treatment with Atorvastatin can reduce serum PSA level, and 2) This reduction is more likely to be due to direct effect and is not related to lowering serum cholesterol levels. Thus, if results of this study are confirmed by large prospective randomized clinical trials with longer follow up period, it will be possible that Atorvastatin could be used in long term as a safe chemoprophylactic agent against prostate cancer in high risk patients.
先前的大型回顾性研究表明，使用他汀类药物进行治疗可使前列腺癌的发病率降低50%，并使血清前列腺特异性抗原（PSA）水平降低达40%。然而，这些研究中的主要问题是缺乏未接受他汀类药物治疗的高胆固醇血症男性对照组。我们进行了一项小型前瞻性对照临床试验，以评估2007年10月至2008年3月转诊至我们教育和治疗中心的高胆固醇血症男性使用阿托伐他汀治疗对血清PSA的影响。在本研究中，在新诊断的高胆固醇血症男性（低密度脂蛋白>130mg/dl）中，选择40例低密度脂蛋白超过190mg/dl的患者作为病例组，接受阿托伐他汀（20mg/天）治疗。在同一人群和同一时期，选择另外40例低密度脂蛋白在130至190mg/dl之间的患者作为第一对照组，仅采用低脂饮食治疗。选择另外40例血清胆固醇正常且未接受任何治疗的患者作为第二对照组。在治疗后的第一个月和第三个月对所有组患者的血脂谱和血清PSA水平进行检测。完成数据收集后，在两次就诊时测量平均血脂和PSA水平，并通过配对t检验相互比较。此外，通过方差分析和Tukey HSD检验比较三组两次就诊时PSA的平均变化。高胆固醇血症患者和正常胆固醇血症患者的平均基线PSA之间没有显著差异（P=0.547）。在病例组中，到第二次就诊时，平均PSA和低密度脂蛋白分别降低了14.1%（P=0.0001）和30%（P=0.0001）。在第一对照组中，平均PSA没有显著变化（P=0.337），而该组的平均低密度脂蛋白降低了9.6%（P=0.0001）。同样，在第二对照组中，到第二次就诊时平均PSA没有显著变化（P=0.309）。此外，将病例组中PSA的平均变化与第一和第二对照组进行比较，差异显著（P=0.0001），而两个对照组之间PSA的平均变化没有显著差异（P=0.615）。本研究结果表明：1）阿托伐他汀短期治疗可降低血清PSA水平，2）这种降低更可能是由于直接作用，与降低血清胆固醇水平无关。因此，如果本研究结果能被更长随访期的大型前瞻性随机临床试验所证实，那么阿托伐他汀有可能长期作为高危患者预防前列腺癌的安全化学预防药物使用。
