Statin use, cholesterol, and prostate cancer in the PSA era

A prevention strategy for prostate cancer does not exist, although it is the most common cancer diagnosis among US men and the second most common worldwide. Up to 40% of prostate cancers that are thought to be curable and have been treated with surgery will recur. Thus, adjuvant therapies for prostate cancer are needed.;Statins are potential agents for primary chemoprevention and adjuvant treatment of prostate cancer. Laboratory data support the biologic plausibility of the hypothesis that statins may protect against prostate cancer with a poorer prognosis and recurrence after surgery. Epidemiologic studies suggest that statins may protect against the development of prostate cancer at an advanced stage. No studies have examined statin use and prostate cancer recurrence after surgery.;Our data suggest that men who use statins are less likely to have prostate tumors with poor pathologic characteristics, supporting previous prospective results that men using statins are less likely to develop advanced prostate cancer. Further, we present the first data suggesting that longer duration statin use may protect against prostate cancer recurrence after prostatectomy.;Our data corroborate two recent studies showing that men who have lower cholesterol are less likely to develop prostate cancer with a poorer prognosis. Thus, the cholesterol-lowering effects of statins may be one of the mechanisms by which they reduce prostate cancer risk. We also show that men with lower cholesterol do not have lower circulating testosterone concentrations; thus, the cholesterol-lowering effects of statins may not influence prostate cancer risk through steroid hormone synthesis.;Using a simulation approach, we demonstrate that detection bias due to a correlation between statin use and PSA screening is unlikely to explain the observed inverse association between statin use and advanced prostate cancer. Further, it is unlikely that statins or cholesterol influencing PSA concentration can explain the observed associations between statin use or low cholesterol and prostate cancer with a poorer prognosis.;We provide the first evidence that, if the association between statin use and advanced prostate cancer is causal, most men would receive prostate cancer benefit from statin use regardless of their other prostate cancer risk factors.