4-5 minutes
Drugs that many men with prostate cancer might already be taking --
cholesterol-lowering statins -- may help extend their survival if they
have a "high-risk" form of the disease, new research suggests.
High-risk patients include men with high blood levels of prostate
specific antigen (PSA) and a "Gleason score" of 8 or more. Gleason
scores are a calculation used to gauge prognosis in prostate cancer. Men
with a high Gleason score may develop difficult-to-treat cancers.
Prior research had suggested that statins and the diabetes drug
metformin (often prescribed together) have anticancer properties.
However, it hasn't been clear which of the two drugs is the bigger
cancer-fighter, or whether either might help against high-risk prostate
cancer.
To help answer those questions, a team led by Grace Lu-Yao of the Sidney
Kimmel Cancer Center--Jefferson Health, in Philadelphia, tracked data
on nearly 13,000 high-risk prostate cancer patients. All were diagnosed
between 2007 and 2011.
The study couldn't prove cause and effect, but it found that statins,
taken alone or with metformin, did seem associated with an increase in
survival.
Men who took both statins and metformin had higher median survival (3.9
years) than those who took statins alone (3.6 years), metformin alone
(3.1 years), or those who did not take either drug (3.1 years).
The study was published Feb. 8 in the journal Cancer Medicine.
"Both metformin and statins have been associated with longer life in
prostate cancer patients, yet because they are commonly prescribed
together, no study we know of has looked at these two medications
separately," Lu-Yao said in a center news release. She's associate
director of population science at the center.
"With respect to prostate mortality, metformin plus statin was
associated with a 36 percent reduction in risk of death followed by
statins alone," Lu-Yao added.
The study also found that those who took one of three types of statin --
atorvastatin, pravastatin or rosuvastatin -- had longer survival than
those who did not take any statins. A similar benefit was not seen with a
fourth statin, lovastatin.
Because prostate cancer thrives on testosterone, patients often receive
treatments that reduce levels of male hormones (androgens). The new
study found that among patients who received such therapies, those who
took atorvastatin had a longer median time to prostate cancer
progression than those who didn't take statins.
It's not clear why such effects were limited to atorvastatin, Lu-Yao
said, but it appears to have the best "bioavailability" of the statin
drugs and lingers longest in the body.
The research team believes that, based on the existing evidence, a
clinical trial should be conducted to assess the effectiveness of
statins and the combination of statins/metformin in extending survival
of prostate cancer patients.
Two prostate cancer specialists unconnected to the new study agreed that the findings show promise.
"It appears that there may be a place in the treatment of prostate
cancer for statins," said Dr. Elizabeth Kavaler, a urology specialist at
Lenox Hill Hospital in New York City. "However, we are not yet at a
point where we can use the data to direct patient care."
She believes testosterone may be key here. According to Kavaler, higher
cholesterol levels promote higher levels of androgens, which in turn
help encourage the growth of prostate cancer. Statins may help slow that
process, Kavaler explained.
Dr. Manish Vira is vice chair for urologic research at The Arthur Smith
Institute for Urology in New Hyde Park, N.Y. He agreed that the findings
are encouraging, and noted that "a dozen actively recruiting clinical
trials using either metformin or a statin in prostate cancer treatment"
are already underway.
More information
The American Cancer Society has more on prostate cancer.
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