Abstract
Background Prostate cancer (PCa) is the ninth most common cause of cancer death globally. Many studies have investigated aspirin exposure and mortality risk among PCa patients, returning inconsistent results. We conducted a comprehensive meta-analysis to explore the association between aspirin exposure and mortality risk among PCa patients and to investigate potential dose/duration/frequency-response relationships. Methods and Results Studies published from 1980 to 2018 of PubMed and EMBASE databases were searched. We included 14 studies with 110,000 participants. Multivariate-adjusted odds ratios (ORs) were pooled using random-effect models. Potential dose/duration/frequency-response relationships were evaluated for aspirin exposure and prostate cancer-specific mortality (PCSM) risk. We did not detect an association between the highest aspirin exposure and mortality risk (PCSM of prediagnostic aspirin exposure, OR: 0.96, 95% confidence interval [CI]: 0.87-1. 07, I2= 0%; PCSM of postdiagnostic aspirin exposure, OR:0.92, 95% CI: 0.77-1.10, I2 = 56.9%; all-cause mortality [ACM] of prediagnostic aspirin exposure, OR: 0.96, 95% CI: 0.88-1.04, I2 = 9.4%; ACM of postdiagnostic aspirin exposure, OR: 0.95, 95% CI: 0.73-1.23, I2 = 88.9%). There was no significant dose/frequency-response association observed for aspirin exposure and PCSM risk. On duration-response analysis, we found that short-term postdiagnostic aspirin exposure (shorter than 2.5 years) increased the risk of PCSM. Conclusions Our meta-analysis suggests that there is no association between aspirin exposure and PCSM risk. Nor is there an association between the highest aspirin exposure and ACM risk among PCa patients. More studies are needed for a further dose/duration/frequency-response meta-analysis.
Highlights
Prostate cancer (PCa) is the most commonly diagnosed cancer among men in over one-half of the countries of the world [1]
After detailed examination of these 24 full-text articles, 11 articles were excluded. 1 study [45] was excluded because the study was a review; 7 studies [31, 46,47,48,49,50,51] were excluded because they were conference abstracts; 2 studies were excluded because the exposure interests reported were nonaspirin nonsteroidal anti-inflammatory drug (NSAID) [29, 52]; 1 study was excluded because the study used the normal population as a control group [11]
All the studies were published in or after 2012. 10 studies [16, 17, 19,20,21, 24,25,26,27] were graded as having high quality, and the remainder were of moderate quality; no study was evaluated as poor quality
Summary
Prostate cancer (PCa) is the most commonly diagnosed cancer among men in over one-half of the countries of the world [1]. Epidemiologic studies have revealed many risk factors for PCa progression and death [6], possibly linked to a more westernized lifestyle, in combination with limited access to effective treatments [5, 7]. Prostate cancer (PCa) is the ninth most common cause of cancer death globally. Many studies have investigated aspirin exposure and mortality risk among PCa patients, returning inconsistent results. We conducted a comprehensive metaanalysis to explore the association between aspirin exposure and mortality risk among PCa patients and to investigate potential dose/duration/frequency-response relationships. Potential dose/duration/frequency-response relationships were evaluated for aspirin exposure and prostate cancer-specific mortality (PCSM) risk. There was no significant dose/frequency-response association observed for aspirin exposure and PCSM risk. On duration-response analysis, we found that short-term postdiagnostic aspirin exposure (shorter than 2.5 years) increased the risk of PCSM. More studies are needed for a further dose/duration/frequencyresponse meta-analysis
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