University of Tampere, School of Medicine, Tampere, Finland.
Department of Mathematics and Systems Analysis, Aalto University, School of Science, Espoo, Finland.
Prostate Cancer Prostatic Dis. 2021 Sep;24(3):917-924. doi: 10.1038/s41391-021-00351-2. Epub 2021 Mar 31.
Statins' cholesterol-lowering efficacy is well-known. Recent epidemiological studies have found that inhibition of cholesterol synthesis may have beneficial effects on prostate cancer (PCa) patients, especially patients treated with androgen deprivation therapy (ADT). We evaluated statins' effect on prostate cancer prognosis among patients treated with ADT.
Our study population consisted of 8253 PCa patients detected among the study population of the Finnish randomized study of screening for prostate cancer. These were limited to 4428 men who initiated ADT during the follow-up. Cox proportional regression model adjusted for tumor clinical characteristics and comorbidities was used to estimate hazard ratios for risk of PSA relapse after ADT initiation and prostate cancer death.
During the median follow-up of 6.3 years after the ADT initiation, there were 834 PCa deaths and 1565 PSA relapses in a study cohort. Statin use after ADT was associated with a decreased risk of PSA relapse (HR 0.73, 95% CI 0.65-0.82) and prostate cancer death (HR 0.82; 95% CI 0.69-0.96). In contrast, statin use defined with a one-year lag (HR 0.89, 95% CI 0.76-1.04), statin use before ADT initiation (HR 1.12, 95% CI 0.96-1.31), and use in the first year on ADT (HR 1.02, 95% CI 0.85-1.24) were not associated with prostate cancer death, without dose dependency.
Statin use after initiation of ADT, but not before, was associated with improved prostate cancer prognosis.
他汀类药物降低胆固醇的功效是众所周知的。最近的流行病学研究发现，胆固醇合成的抑制可能对前列腺癌（PCa）患者有益，特别是接受雄激素剥夺治疗（ADT）的患者。我们评估了他汀类药物对接受 ADT 治疗的前列腺癌患者预后的影响。
我们的研究人群由芬兰前列腺癌筛查随机研究的研究人群中检测到的 8253 例前列腺癌患者组成。这些患者仅限于在随访期间开始 ADT 的 4428 名男性。使用 Cox 比例风险回归模型调整肿瘤临床特征和合并症，以估计 ADT 起始后 PSA 复发和前列腺癌死亡的风险比。
在 ADT 起始后中位随访 6.3 年后，研究队列中有 834 例前列腺癌死亡和 1565 例 PSA 复发。ADT 后使用他汀类药物与 PSA 复发风险降低相关（HR 0.73，95%CI 0.65-0.82）和前列腺癌死亡风险降低（HR 0.82；95%CI 0.69-0.96）。相比之下，使用他汀类药物定义为一年的滞后（HR 0.89，95%CI 0.76-1.04），ADT 起始前使用他汀类药物（HR 1.12，95%CI 0.96-1.31），以及在 ADT 第一年使用（HR 1.02，95%CI 0.85-1.24）与前列腺癌死亡无关，没有剂量依赖性。
ADT 起始后而不是起始前使用他汀类药物与改善前列腺癌预后相关。
