REPLY

Abstract

Sir, There are a number of studies that suggest that statins may be protective against prostate cancer. Recently, Farwell et al. 1 reported a statistically significant reduced risk of total and high-grade prostate cancer in statin users from a Veterans Affairs population. We thank Goldstein and Mascitelli for their comprehensive description of a contrasting viewpoint wherein statins may promote prostate carcinogenesis. In the present study 2, we found that patients who were on a statin were at a statistically significant increased risk for biochemical recurrence (BCR) after radical prostatectomy. We think that this may have been due to a masking effect of statins on the true aggressiveness of the disease at the time of diagnosis. This was supported by the finding that statin users had a lower PSA level before surgery but were more likely to experience BCR. Goldstein and Mascitelli theorise that statin use in conjunction with surgery may promote angiogenesis and immunosuppression thereby promoting cancer and leading to an increased risk of BCR. While this hypothesis is interesting, we have no data to support this mechanism of action in our study 2 and therefore cannot conclude that statins play a direct tumorigenic role from a molecular standpoint. We think that the data on statins and prostate cancer remain controversial. Furthermore, Papadopoulus et al. 3 describe several molecular mechanisms by which statins may both prevent and promote prostate cancer. We encourage further research and emphasize that despite some evidence for the anti-cancer effects of statins, well-designed studies are needed before recommending statins as chemoprevention or adjunctive therapy in prostate cancer.