Role of serum cholesterol and statin use in the risk of prostate cancer detection and tumor aggressiveness.

Juan Morote,Juan Carles,Anna Celma,Mireia Olivan,Jacques Planas,Andreas Doll,Andreas Doll,Jaume Reventós,Jaume Reventós,Jaume Reventós,Andreas Doll,Jaume Reventós,Inés De Torres,José Placer

doi:10.3390/ijms150813615

Abstract

The aim of this study was to analyze the relationship between statin use along with serum cholesterol levels and prostate cancer (PCa) detection and aggressiveness. Statin users of three years or more and serum cholesterol levels (SC) were assessed in 2408 men scheduled for prostate biopsy. SC was classified as normal (NSC: <200 mg/dL) or high (HSC: >200 mg/dL). High-grade PCa (HGPCa) was considered if the Gleason score was greater than 7. Statin users comprised 30.9% of those studied. The PCa detection rate was 31.2% of men on statins and 37% of non-statin users (p < 0.006). The PCa detection rate was 26.3% in men with NSC and 40.6% in those with HSC (p < 0.001). In the subset of NSC men, the PCa rate was 26.5% for statin users and 26.2% for non-users (p = 0.939), while in men with HSC, the PCa rate was 36.4% for statin users and 42.0% for non-statin users (p = 0.063). The HGPCa rate was 41.8% for statin users and 32.5% for non-users (p = 0.012). NSC men had a 53.8% rate of HGPCa, while the rate was only 27.6% in HSC men (p < 0.001). NSC men on statins had an HGPCa rate of 70.2%, while non-statin users had a rate of 41.2% (p < 0.001). The HGPCa rate for HSC men on statins was 18.8%, while the rate was 30.0% (p = 0.011) for non-users. Logistic regression analysis suggested that serum cholesterol levels could serve as an independent predictor of PCa risk, OR 1.87 (95% CI 1.56–2.24) and HGPCa risk, OR 0.31 (95% CI 0.23–0.44), while statin usage could not. Statin treatment may prevent PCa detection through serum cholesterol-mediated mechanisms. A disturbing increase in the HGPCa rate was observed in statin users who normalized their serum cholesterol.

Highlights

Prostate cancer (PCa) is the most commonly diagnosed neoplasm among men in Europe and the US [1,2]
There is already a strong foundation of basic scientific research that demonstrates how statins inhibit many pathways of cancer formation and progression through cholesterol and non-cholesterol mediated mechanisms [26]. Those specific cholesterol-mediated mechanisms have presented a challenge in prostate cancer, especially after a study conducted on the placebo arm of the prostate cancer prevention trial
We observed a 36% rate of prostate cancer detection in statin non-users with high serum cholesterol, while the rate for those men with high serum cholesterol who used statins was 42%. These results suggest that the role of statins in prostate cancer prevention could be restricted to those men, whose serum cholesterol levels were normalized after statins use

Summary

Introduction

Prostate cancer (PCa) is the most commonly diagnosed neoplasm among men in Europe and the US [1,2]. Within the same geographic areas, hypercholesterolemia is one of the most frequent conditions observed in men at the age of PCa risk [3]. Examining the relationship between PCa, statins use and serum cholesterol would seem reasonable, especially taking into consideration recent findings in the literature. The relationship between serum cholesterol and the incidence of PCa and its mortality have been studied by several groups with inconsistent results. Some studies found a positive association between serum cholesterol and PCa mortality [5,6], while others revealed either an inverse relationship [7,8]

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