The Influence Of Statin Medications On Prostate-specific Antigen Levels

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Statins;  Cholesterol
Article Date: 15 Nov 2008 - 1:00 PDT

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UroToday.com - According to a report by Dr. Robert J. Hamilton and associates that appears in the November 5, 2008 issue of the Journal of the National Cancer Institute, statin use lowers PSA levels, and as a result may confound the detection of prostate cancer (CaP) in these patients.

Statins are lipid-lowering agents in widespread use in the US. Several reports suggest that men on statins have a reduction in the risk of advanced CaP that ranges from 25% to 75%. In this study, the investigators sought to determine the effect of statins on serum PSA levels. A retrospective study population of 1,214 men who had filled an outpatient prescription for a statin between 1990 and 2006 was identified in the Durham VA Medical Center database. Men were excluded if they had a diagnosis of CaP, underwent treatment for CaP, had a TURP or prostatitis or took dutasteride or finasteride. Pre- and post-statin initiation PSA and LDL levels were required. The primary study endpoint was the percentage change in PSA after starting a statin. The change in cholesterol parameters was used as an indication of the biologic effect of statins on cholesterol synthesis in individual patients and for patient compliance.

Mean patient age at onset of statin use was 60 years. Most men were white (60%), overweight (39%) or obese (46%). Simvastatin was the statin prescribed in 95% of patients, and the most common starting dose was 20mg. Median pre-statin PSA was 0.9ng/ml and median LDL was 144mg/dl. A median decrease in LDL of 27.5% was noted at an average time of 227 days after initiation of statin use. The median change in PSA after starting a statin was a decrease of 4.1%. The median time between the pre- and post-statin PSA levels was 367 days and the median time from starting a statin was 214 days. A subset of 579 men was identified as having an additional PSA prior to the pre-statin PSA and the change at an average of 396 days was 0%. The median change in PSA after starting a stain in this subset was similar to the whole population at minus 4.1%. PSA decline was linearly associated with a decline in LDL and for every 10% LDL decline there was a PSA decline of 1.64%. Men who did not demonstrate LDL change after statin initiation experienced a 2.1% PSA rise. Statin doses equal to or greater than 20mg were associated with an 8.5% and 9.4% decline in PSA, respectively.

The researchers applied three commonly used PSA thresholds for prostate biopsy; >4.0, >3.0, and >2.5ng/ml to determine if the statin-related drop in PSA would then result in no biopsy being performed. The median absolute PSA decline was 0.6, 0.5, and 0.4ng/ml with 39%, 26%, and 24% respectively of men falling below the threshold for biopsy.

Hamilton RJ, Goldberg KC, Platz EA, Freedland SJ
J Natl Cancer Inst. 2008 Nov 5;100(21):1511-810.1093/jnci/djn362

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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