2281: Statin Use Prior to Radiation Therapy for Prostate Cancer Does Not Improve Outcome: The Fox Chase Experience

Abstract

Statins are antiangiogenic agents and antiangiogenic factors have been shown to enhance radiation response. In this report, we investigate the use of statins and patient outcome following radiotherapy (RT) for prostate cancer. To determine if statin use before, during and after RT influences patient outcome. Patient records of 983 men diagnosed with prostate cancer and treated with 3D- conformal RT between January 1995 and December 2000 were retrospectively analyzed. Patients initially treated with androgen deprivation therapy were excluded from this study. Median age at time of initial treatment was 68.8 years range 43–84 years). There were 90% patients with T1-T2 and 3.5% with T3-T4 disease. T-stage could not be verified in 62 patients (6.3%). Gleason scores were 2–6 in 677 (69%), 7 in 255 (26%) and 8–10 in 51 (5%) patients. Median initial PSA (iPSA) was 7.4 ng/mL (range 0.03–68 ng/mL). The iPSA was less than 10 ng/mL in 691 (70.4%), 10–20 ng/mL in 227 (23.1%) and greater than 20 ng/mL in 64 (6.5%) patients. One hundred seventy eight (18.1%) [AP1] patients reported concurrent statin use during RT, with 47 (4.1%) of those patients having initiated statin use prior to RT. Median RT dose was 75.8 Gy (range 62.8- 82.1 Gy). Biochemical failure (BF) was defined using the ASTRO (3 rises) and Nadir+2 ng/mL (Phoenix) criteria. Median follow-up was 58.1 months. There appeared to be no favorable correlation between pre-RT statin use and BF by either definition, distant metastasis, cause-specific and overall mortality and GI/GU toxicities as assessed by univariate and multivariate analyses. The significant factors in the MVAs (e.g., age, radiation dose, Gleason score, pretreatment PSA and T- stage for BF) are displayed in Table 1.Table 1Actuarial and hazard ratio estimates for clinical and mortality endpoints for pre-treatment statin use (n=178) vs others (n=805)Total Number of EventsActuarial EstimatePre-Tx Statin Use vs Others Cox Proportional Hazards Multivariate (stepwise)HRp-ValueCovariates Included⁎Covariates: A=age (continuous), D=dose (continuous), G=Gleason score (2–6 vs 7 vs 8–10), P=iPSA (continuous), S=Stage (T1-T2a vs T2b-T2c vs T3-T4).7 yr Survival Rates (%)p-ValPre Tx StatinNo StatinPre Tx StatinNo StatinOverall Mortality2110284.283.50.631.170.51A,GCause Spec. Mort2798.098.70.591.660.52PDistant Mets42297.596.20.800.870.79A,GBCF-Nadir+22513178.673.20.770.980.96A,G,P,SBCF-Astro3116378.971.70.330.960.83A,D,G,P,SHR=Hazard ratio Covariates: A=age (continuous), D=dose (continuous), G=Gleason score (2–6 vs 7 vs 8–10), P=iPSA (continuous), S=Stage (T1-T2a vs T2b-T2c vs T3-T4). Open table in a new tab HR=Hazard ratio Contrary to previous reports, our current study does not show any improvement in patient outcome from pre-treatment statin use in men treated with RT.