在一项前瞻性筛查试验（ERSPC Aarau）中，定期服用阿司匹林对 PSA 值、前列腺癌发病率和总生存率的影响。
Influence of regular aspirin intake on PSA values, prostate cancer incidence and overall survival in a prospective screening trial (ERSPC Aarau).
机构信息
Department of Urology, University Hospital Zurich, Zurich, Switzerland.
Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland.
出版信息
World J Urol. 2020 Oct;38(10):2485-2491. doi: 10.1007/s00345-019-03054-5. Epub 2019 Dec 21.
OBJECTIVES
To analyze the influence of aspirin (ASA) intake on PSA values and prostate cancer (PCa) development in a prospective screening study cohort.
METHODS
4314 men from the Swiss section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) were included. A transrectal prostate biopsy was performed in men with a PSA level ≥ 3 ng/ml. Mortality data were obtained through registry linkages. PCa incidence and grade, total PSA, free-to-total PSA and overall survival were compared between ASA users and non-users.
RESULTS
Median follow-up time was 9.6 years. In 789 men (18.3%) using aspirin [ASA +], the overall PCa incidence was significantly lower (6.8% vs. 9.6%, p = 0.015), but the multivariate Cox regression analysis showed no significant decrease in risk of PCa diagnosis (HR 0.84, p = 0.297). Total PSA values were significantly lower in ASA users for both baseline (1.6 vs. 1.8 ng/ml, p = 0.007) and follow-up visits (1.75 vs. 2.1 ng/ml, p < 0.001). Multivariate Cox regression analysis predicted significantly higher overall mortality risk among ASA users (HR 1.46, p = 0.009).
CONCLUSIONS
In our study population, PCa incidence was significantly reduced among patients on aspirin. While we did not observe a statistically significant PCa risk reduction during the follow-up period, we found lower PSA values among ASA users compared to non-users, with a more distinct difference after 4 years of ASA intake, suggesting a cumulative effect and a potential protective association between regular ASA intake and PCa development. As for clinical practice, lowering PSA cutoff values by 0.4 ng/ml could be considered in long-term ASA users to avoid a potential bias towards delayed PCa detection.
目的
在一项前瞻性筛查研究队列中，分析阿司匹林（ASA）摄入对 PSA 值和前列腺癌（PCa）发展的影响。
方法
纳入来自瑞士欧洲前列腺癌筛查随机研究（ERSPC）部分的 4314 名男性。对 PSA 水平≥3ng/ml 的男性进行经直肠前列腺活检。通过登记处链接获取死亡率数据。比较 ASA 使用者和非使用者之间的 PCa 发病率和分级、总 PSA、游离 PSA 与总 PSA 比值和总生存率。
结果
中位随访时间为 9.6 年。在 789 名使用阿司匹林（ASA+）的男性中，总 PCa 发病率显著降低（6.8%比 9.6%，p=0.015），但多变量 Cox 回归分析显示 PCa 诊断风险无显著降低（HR 0.84，p=0.297）。ASA 使用者的总 PSA 值在基线时（1.6 比 1.8ng/ml，p=0.007）和随访时（1.75 比 2.1ng/ml，p<0.001）均显著降低。多变量 Cox 回归分析预测 ASA 使用者的总死亡率风险显著升高（HR 1.46，p=0.009）。
结论
在我们的研究人群中，阿司匹林使用者的 PCa 发病率显著降低。虽然我们在随访期间未观察到统计学上显著的 PCa 风险降低，但与非使用者相比，ASA 使用者的 PSA 值较低，在 4 年的 ASA 摄入后差异更为明显，提示存在累积效应，以及定期 ASA 摄入与 PCa 发展之间可能存在保护关联。就临床实践而言，在长期使用 ASA 的患者中，可以考虑将 PSA 截止值降低 0.4ng/ml，以避免潜在的 PCa 检测延迟偏差。
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