The suggested unique association between the various statin subgroups and prostate cancer
Goldberg H, Mohsin FK, Saskin R, Kulkarni GS, Berlin A, Kenk M, Wallis CJD, Klaassen Z, Chandrasekar T, Ahmad AE, Sayyid RK, Saarela O, Penn L, Alibhai SMH, Fleshner N. Eur Urol Focus. 2021; 7(3):537-45. Epub 2020 Jun 30. DOI: https://doi.org/10.1016/j.euf.2020.06.005
Background — The chemopreventive effect of various medications in prostate cancer (PCa) has gained interest. Specifically, the potential impact of statins on PCa incidence has been studied, but solely as a “drug family” overlooking the distinctive pharmacological properties of its two main subgroups: hydrophilic and hydrophobic statins.
Objective — To assess the impact of statin subgroups on PCa-specific mortality (PCSM), PCa diagnosis, and undergoing another prostate biopsy.
Design, Setting, and Participants — This is a population-based cohort study in Ontario identifying all men aged ≥66 yr with a history of a single negative prostate biopsy (representing healthy men at risk for PCa) between 1994 and 2016, who were not on any of the analyzed medications prior to the study, with a median follow-up of 9.42 yr (interquartile range 8.03 yr).
Outcome Measurements and Statistical Analysis — Using multivariable cause-specific hazard models with time-dependent covariates, the association of hydrophobic and hydrophilic statins with all study outcomes was analyzed. Other putative chemopreventive medications (including alpha-blockers, 5-alpha-reductase inhibitors, and proton-pump inhibitors), age, rurality, comorbidities, and study inclusion year were included in the models.
Results and Limitations — Overall, 21 512 men were identified. Statins were taken by 11 401 patients (50.3%), 5184 men (24.1%) were diagnosed with PCa, and 805 (3.7%) died from it. Overall, 7556 patients (35.1%) underwent another biopsy. Any use of hydrophilic statins was associated with a 32.4% (95% confidence interval [CI] 12.9–47.5%), a 20% (95% CI 10–28%), and an 18% (95% CI 6.1–27.3%) decreased risk of PCSM, undergoing another prostate biopsy, and being diagnosed with PCa, respectively. Hydrophobic statins were associated with 17% (95% CI 2–31%) decreased PCSM. The study is limited by its retrospective nature, selection bias, and accompanying health-administrative database inaccuracies.
Conclusions — Use of any statin may be associated with a lower hazard of PCSM, with hydrophilic statins showing a greater association with decreased PCa diagnosis rates. Preferentially prescribing one statin subgroup over another in men needs further exploration.
Patient Summary — Use of any statin may be associated with a lower probability of dying from prostate cancer. Hydrophilic statins (rosuvastatin and pravastatin) may also be more positively associated with a lower risk of undergoing an additional prostate biopsy and being diagnosed with prostate cancer in men aged ≥66 yr.