Veitonmäki T, Murtola T J, Määttänen L, Taari K, Stenman U-H, Tammela T L J, Auvinen A
1] Department of Urology, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland [2] School of Health Sciences, University of Tampere, Medisiinarinkatu 3, 33520 Tampere, Finland.
1] Department of Urology, Tampere University Hospital, Teiskontie 35, 33521 Tampere, Finland [2] School of Medicine, University of Tampere, Lääkärinkatu 1, 33520 Tampere, Finland.
Br J Cancer. 2014 Sep 23;111(7):1421-31. doi: 10.1038/bjc.2014.381. Epub 2014 Jul 10.
The association between nonsteroidal antiinflammatory drugs (NSAIDs) and prostate cancer risk remains controversial. We examined the risk among NSAID users in 78 615 men in the Finnish Prostate Cancer Screening Trial.
We obtained information on NSAID prescription usage from Finnish nationwide prescription database and on over-the-counter use by a questionnaire. Prostate cancer cases were identified from the Finnish Cancer Registry.
Prostate cancer risk was elevated among current NSAID prescription users irrespective of screening (hazard ratio (HR)=1.45, confidence interval (95% CI)=1.33-1.59 and HR=1.71, 95% CI=1.58-1.86 in the screening and control arm, respectively), but not for previous use of NSAIDs. The risk increase was similar among coxib and acetaminophen current users, and stronger for metastatic prostate cancer (HR=2.41, 95% CI=1.59-3.67 and HR=3.44, 95% CI=2.60-4.55 in the screening and control arm, respectively). Previous use of NSAIDs, aspirin use and over-the-counter NSAID usage were not associated with prostate cancer.
Differing association for current and previous use suggests that the risk increase is unlikely to be directly caused by the medication, but may be due to the conditions indicating NSAID prescription usage, such as symptoms of undiagnosed prostate cancer. To reduce inconsistency between the study outcomes, future epidemiological studies on NSAID use and prostate cancer risk should assess the indications for NSAID usage.
非甾体抗炎药（NSAIDs）与前列腺癌风险之间的关联仍存在争议。我们在芬兰前列腺癌筛查试验的78615名男性中研究了NSAIDs使用者的风险。
我们从芬兰全国处方数据库获取了NSAIDs处方使用信息，并通过问卷调查获取了非处方使用情况。前列腺癌病例来自芬兰癌症登记处。
当前NSAIDs处方使用者的前列腺癌风险升高，无论是否进行筛查（筛查组和对照组的风险比（HR）分别为1.45，95%置信区间（CI）=1.33 - 1.59和HR = 1.71，95% CI = 1.58 - 1.86），但既往使用NSAIDs者则不然。昔布类药物和对乙酰氨基酚当前使用者的风险增加相似，转移性前列腺癌的风险增加更明显（筛查组和对照组的HR分别为2.41，95% CI = 1.59 - 3.67和HR = 3.44，95% CI = 2.60 - 4.55）。既往使用NSAIDs、使用阿司匹林和非处方NSAIDs的使用与前列腺癌无关。
当前使用和既往使用的关联不同表明，风险增加不太可能直接由药物引起，而可能是由于表明NSAIDs处方使用的情况，如未确诊前列腺癌的症状。为减少研究结果之间的不一致性，未来关于NSAIDs使用与前列腺癌风险的流行病学研究应评估NSAIDs使用的指征。
