Impact of Statin Use on BCR After Radical Prostatectomy
Impact of Statin Use on BCR After Radical Prostatectomy
Background: The impact of statin use on biochemical recurrence (BCR) in patients treated with radical prostatectomy (RP) remains controversial.
Methods: We retrospectively evaluated 6842 patients who underwent RP for clinically localized prostate cancer (PC) between 2000 and 2011. Uni- and multivariable cox regression models addressed the association of statin use with BCR.
Results: Overall, 2275 (33.3%) patients used statins. Statin users were older and had a higher rate of positive surgical margins than patients not using statins (P-values ≤0.05). Within a median follow-up of 25 months (interquartile range: 8–42 months), 778 (11.4%) patients experienced BCR. Actuarial estimate 5-years BCR-free survival was 82%±1 for patients without statin use and 84±1% for patients using statins (P=0.05); statin use was not associated with BCR (hazard ratio: 0.88, 95% confidence interval: 0.76–1.03, P=0.10) after adjusting for the effects of standard clinicopathologic features.
Conclusions: In PC patients undergoing RP, statin use was not independently associated with lower risk of BCR.
Radical prostatectomy (RP) is the most widely used treatment in patients with clinically localized prostate cancer (PC). Unfortunately, up to 40% of patients experience disease recurrence during long-term follow-up (FU) despite apparently successful surgery. Statins or 3-hydroxy-3-methylglutarylcoenzyme A reductase inhibitors are widely used medications for hypercholesterolemia. In recent years, there is a constant increase in numbers of statin users. Studies showed that lowering of low-density lipoprotein cholesterol significantly reduced the incidence of major vascular events such as myocardial infarction or coronary death, stroke or coronary revascularization procedure. Interestingly, statin use has been associated as well with reduced cancer-related mortality. The impact of statin use on the incidence and natural history of PC remains controversial. A recent meta-analysis on statin use and risk of PC including a total of 27 studies with 1.9 million male subjects provided further evidence that statins may reduce the risk of both having any PC and clinically significant PC. Moreover, in PC patients treated with external-beam radiation therapy, statin use has may be associated with a reduced risk of biochemical recurrence (BCR). However, in one study, the beneficial effect was limited to high-risk patients and another could not detect any association of statin use with PC outcomes after external-beam radiation therapy. A total of seven studies investigated the association of statin use with BCR in PC patients treated with RP. Of these, five studies showed no association, whereas in one study statin use was associated with increased and in one study with decreased risk of BCR.
As previous studies cover heterogeneous, limited sized cohorts, a further analysis of the association of statin use with BCR after RP for PC in a large cohort is warranted. For this purpose, we assessed a multicenter cohort of patients treated with RP for clinically localized PC. Based on the previously published literature, we hypothesized that statin use is not associated with BCR after RP for PC.
Abstract and Introduction
Abstract
Background: The impact of statin use on biochemical recurrence (BCR) in patients treated with radical prostatectomy (RP) remains controversial.
Methods: We retrospectively evaluated 6842 patients who underwent RP for clinically localized prostate cancer (PC) between 2000 and 2011. Uni- and multivariable cox regression models addressed the association of statin use with BCR.
Results: Overall, 2275 (33.3%) patients used statins. Statin users were older and had a higher rate of positive surgical margins than patients not using statins (P-values ≤0.05). Within a median follow-up of 25 months (interquartile range: 8–42 months), 778 (11.4%) patients experienced BCR. Actuarial estimate 5-years BCR-free survival was 82%±1 for patients without statin use and 84±1% for patients using statins (P=0.05); statin use was not associated with BCR (hazard ratio: 0.88, 95% confidence interval: 0.76–1.03, P=0.10) after adjusting for the effects of standard clinicopathologic features.
Conclusions: In PC patients undergoing RP, statin use was not independently associated with lower risk of BCR.
Introduction
Radical prostatectomy (RP) is the most widely used treatment in patients with clinically localized prostate cancer (PC). Unfortunately, up to 40% of patients experience disease recurrence during long-term follow-up (FU) despite apparently successful surgery. Statins or 3-hydroxy-3-methylglutarylcoenzyme A reductase inhibitors are widely used medications for hypercholesterolemia. In recent years, there is a constant increase in numbers of statin users. Studies showed that lowering of low-density lipoprotein cholesterol significantly reduced the incidence of major vascular events such as myocardial infarction or coronary death, stroke or coronary revascularization procedure. Interestingly, statin use has been associated as well with reduced cancer-related mortality. The impact of statin use on the incidence and natural history of PC remains controversial. A recent meta-analysis on statin use and risk of PC including a total of 27 studies with 1.9 million male subjects provided further evidence that statins may reduce the risk of both having any PC and clinically significant PC. Moreover, in PC patients treated with external-beam radiation therapy, statin use has may be associated with a reduced risk of biochemical recurrence (BCR). However, in one study, the beneficial effect was limited to high-risk patients and another could not detect any association of statin use with PC outcomes after external-beam radiation therapy. A total of seven studies investigated the association of statin use with BCR in PC patients treated with RP. Of these, five studies showed no association, whereas in one study statin use was associated with increased and in one study with decreased risk of BCR.
As previous studies cover heterogeneous, limited sized cohorts, a further analysis of the association of statin use with BCR after RP for PC in a large cohort is warranted. For this purpose, we assessed a multicenter cohort of patients treated with RP for clinically localized PC. Based on the previously published literature, we hypothesized that statin use is not associated with BCR after RP for PC.
