In Hong Kong, prostate cancer (PCa) was the third most common cancer in men as of 2016.1 PCa is a slow-growing cancer, with a long latency period of up to 15 to 20 years.2 The high lifetime incidence and slow rate of PCa development makes it an attractive target for chemoprevention.2 Statins are a family of cholesterol-lowering medications with anti-proliferative and pro-apoptotic properties that are among the most prescribed medications worldwide.2,3 It is suggested that statins could also inhibit carcinogenesis and impact cancer outcomes.3 A hospital-based cohort study reported that the use of statins might be associated with reduced PCa risk, with a greater risk reduction for PCa of higher Gleason score. These results were recently published in Cancer Medicine.
Studies showed that statins could inhibit angiogenesis, the proliferation, migration and/or adhesion and invasion of cells, and could promote the apoptosis of PCa cells.4 Epidemiological data have also emerged demonstrating an inverse association between statin use and the risk of advanced PCa.4
Wang et al. used a hospital-based longitudinal cohort study to investigate the association of statin use with PCa risk and specific Gleason score at diagnosis.2 The study was conducted at a tertiary hospital in the Southeastern United States (US) based on electronic medical records (EMR) data.2 13,065 patients with at least one visit of the urologic clinic due to any prostatic conditions between November 1994 and January 2016 were enrolled.2 All statins available on the US market were included. The outcome of interest was newly diagnosed PCa, which was extracted from EMR databases using ICD-9 codes.2 Gleason score of <7 was referred to as low-grade PCa, and ≥8 as high-grade PCa, for the purposes of main analysis.2
Among the 13,065 men included, the median age at baseline was 62 years.2 29.4% used statins during the study period, and over a total of 94,801.6 person-years follow-up, 2,976 patients were diagnosed with PCa.2 In a model fully adjusted for confounders, such as age, race, smoking status, body mass index, and PCa family history, statin use was significantly associated with decreased risk of overall PCa (adjusted HR [aHR]=0.80; 95% CI: 0.71-0.90) compared with no statin use.2 A decreasing pattern in PCa risk was observed with increased cumulative duration (≥11 months) and dose of statin use (≥121 defined daily doses).2
In the PCa Gleason grade-stratified analysis, statin use was associated with decreased risk of both low-grade (aHR=0.85; 95% CI: 0.74-0.96) and high-grade PCa (aHR=0.54; 95% CI: 0.42-0.69) compared with no statin use.2 The risk of low-grade PCa decreased with both increasing duration and dose of statin use.2 However, the protective association was only observed when statins were used for ≥30 months or ≥121 defined daily doses. Short-term statin use was associated with an increased low-grade PCa risk.2 With high-grade PCa, a decreased trend in the risk with increasing duration and statin dose was also observed, but no risk increase was noted with low-duration or low-dose groups.2
These results indicated that statin use might be associated with a decreased risk of both low-grade and high-grade Gleason score PCa, particularly when statins had been used for a relatively long duration.2 More studies are needed to confirm these findings.2 In Hong Kong, PCa recorded the largest increase in incidence rate among cancers common in males over the last two decades.1 In 2015, the prescription prevalence of statins was 8.6% in Hong Kong, a near five-fold increase from 2004.5 Future drugs against prostate cancer could be used separately or in combination with statins to reduce PCa mortality and/or morbidity if the findings are confirmed.4
1. Centre for Health Protection, Department of Health – Prostate Cancer. Prostate cancer. https://www.chp.gov.hk/en/healthtopics/content/25/5781.html. Published April 8, 2019. Accessed October 22, 2019.
2. Wang K et al. Association of statin use with risk of Gleason score-specific prostate cancer: A hospital-based cohort study. Cancer Medicine. 0(0):1-9.
3. Park HS et al. Statins and prostate cancer recurrence following radical prostatectomy or radiotherapy: a systematic review and meta-analysis. Ann Oncol. 2013;24(6):1427-1434.
4. Alfaqih MA et al. The current evidence on statin use and prostate cancer prevention: are we there yet? Nat Rev Urol. 2017;14(2):107-119.
5. Blais JE et al. Trends in statin prescription prevalence, initiation, and dosing: Hong Kong, 2004–2015. Atherosclerosis. 2019;280:174-182.