Abstract A113 Purpose NSAIDs such as aspirin are commonly used to prevent cardiovascular disease, and several prior studies suggest NSAIDs may also reduce prostate inflammation and prostate cancer risk. We investigated the association between NSAID use, PSA, and prostate volume, hypothesizing lower PSA and volume levels with NSAID use. Methods The Nashville Men’s Health Study utilizes a multi-centered, rapid-recruitment protocol to collect clinical, biological, behavioral, and body measurement data from 1,277 men over age 40 years and scheduled for diagnostic prostate biopsy. Approximately 95% of eligible men approached for recruitment agree to participate. NSAID use was ascertained by survey and clinical interview, and medical charts were reviewed to ascertain current PSA levels, prostate volume, and clinical diagnoses following biopsy. The distributions of PSA level and prostate volume data were natural log transformed prior to analysis. In a linear model, mean PSA and volume scores across NSAID categories were adjusted for age; race (black/white); family history (yes/no); number of prior PSA tests (1,2, 3 or more); BMI; WHR; height; or treatment for BPH (steroid reductase inhibitors, other), diabetes (Yes/No), CVD (Yes/No), hyperlipidemia (Yes/No); and the diagnosis of PIN, atypical findings suspicious for cancer, low-grade cancer, or high-grade cancer following biopsy. PSA and prostate volume scores were back-transformed and geometric mean values are reported. Results Approximately 46% of subjects reported taking an NSAID, primarily aspirin (37% of subjects). After adjusting for age, race, family prostate cancer history, obesity, and treatment for BPH, CVD, hyperlipidemia, and diabetes; aspirin was significantly associated with lower PSA levels (7.3 vs. 8.0 ng/ml, p=0.01). This effect of aspirin on PSA was greatest among men with a prostate volume of 60 mls or more (8.6 vs. 9.7 ng/ml, p=0.06), men diagnosed with prostate cancer (6.1 vs. 7.3 ng/ml, p<0.01), or men with both cancer and prostate enlargement (7.3 vs. 12.7 ng/ml, p<0.01). NSAID use was not significantly associated with prostate volume (47.6 vs. 46.0 mls, p=0.16). Conclusions Aspirin use was significantly associated with lower PSA levels. Controlling for BMI, WHR, and the use of medications to treat CVD, hyperlipidemia, BPH, and diabetes had little effect on the association between aspirin use and PSA levels, suggesting aspirin was not simply a proxy for these comorbid conditions or their associated treatments. These results may suggest that aspirin use decreases the ability to detect prostate cancer and may contribute to prior investigations reporting a protective association between NSAID use and prostate cancer risk. Implications for prostate cancer screening recommendations and for clinical decision-making will require further investigation. Citation Information: Cancer Prev Res 2008;1(7 Suppl):A113.
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