THE UCSF CANCER OF THE PROSTATE RISK ASSESSMENT (CAPRA) SCORE ACCURATELY PREDICTS METASTASIS, PROSTATE CANCER MORTALITY, AND ALL-CAUSE MORTALITY REGARDLESS OF TREATMENT TYPE

Purpose Diabetes is associated with lower risk of prostate cancer. Most men with diabetes are obese, and obesity is associated with greater prostate cancer mortality. Whether diabetes influences outcomes after prostate cancer diagnosis is unknown. Patients and Methods We assessed the relationship between prevalent diabetes and mortality using data from Radiation Therapy Oncology Group Protocol 92-02, a large randomized trial of men (N = 1,554) treated with radiation therapy and short-term versus long-term adjuvant goserelin for locally advanced prostate cancer. Regression and proportional hazard models were performed to evaluate relationships between prevalent diabetes and all-cause mortality, prostate cancer mortality, and non–prostate cancer mortality. Covariates included age, race, tumor stage, Gleason score, prostate-specific antigen, weight, and treatment arm. Results There were a total of 765 deaths; 210 (27%) were attributed to prostate cancer. In univariate analyses, prevalent diabetes was associated with greater all-cause mortality and non–prostate cancer mortality but not prostate cancer mortality. After controlling for other covariates, prevalent diabetes remained significantly associated with greater all-cause mortality and non–prostate cancer mortality (hazard ratio [HR] = 2.12; 95% CI, 1.69 to 2.66; P < .0001) but not prostate cancer mortality (HR = 0.80; 95% CI, 0.51 to 1.25; P = .34). In contrast, weight was associated with greater prostate cancer mortality (HR = 1.77; 95% CI, 1.22 to 2.55; P = .002) but not all-cause or non–prostate cancer mortality. Conclusion Weight but not prevalent diabetes is associated with greater prostate cancer mortality in men receiving combined modality treatment for locally advanced disease. These observations suggest that the association between obesity and greater prostate cancer mortality is mediated by mechanism(s) other than the characteristic metabolic alterations of diabetes.

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Use of Statins and the Risk of Death in Patients With Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2013.49.4757 ◽

2014 ◽

Vol 32 (1) ◽

pp. 5-11 ◽

Cited By ~ 537

Author(s):

Oriana Yu ◽

Maria Eberg ◽

Serge Benayoun ◽

Armen Aprikian ◽

Gerald Batist ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Mortality ◽

Proportional Hazards ◽

Large Population ◽

Cox Proportional Hazards ◽

Reverse Causality ◽

Risk Of Death ◽

Prostate Cancer Mortality ◽

All Cause Mortality ◽

Risk Of Cancer

Purpose To determine whether the use of statins after prostate cancer diagnosis is associated with a decreased risk of cancer-related mortality and all-cause mortality and to assess whether this association is modified by prediagnostic use of statins. Patients and Methods A cohort of 11,772 men newly diagnosed with nonmetastatic prostate cancer between April 1, 1998, and December 31, 2009, followed until October 1, 2012, was identified using a large population-based electronic database from the United Kingdom. Time-dependent Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% CIs of mortality outcomes associated with postdiagnostic use of statins, lagged by 1 year to account for latency considerations and to minimize reverse causality, and considering effect modification by prediagnostic use of statins. Results During a mean follow-up time of 4.4 years (standard deviation, 2.9 years), 3,499 deaths occurred, including 1,791 from prostate cancer. Postdiagnostic use of statins was associated with a decreased risk of prostate cancer mortality (HR, 0.76; 95% CI, 0.66 to 0.88) and all-cause mortality (HR, 0.86; 95% CI, 0.78 to 0.95). These decreased risks of prostate cancer mortality and all-cause mortality were more pronounced in patients who also used statins before diagnosis (HR, 0.55; 95% CI, 0.41 to 0.74; and HR, 0.66; 95% CI, 0.53 to 0.81, respectively), with weaker effects in patients who initiated the treatment only after diagnosis (HR, 0.82; 95% CI, 0.71 to 0.96; and HR, 0.91; 95% CI, 0.82 to 1.01, respectively). Conclusion Overall, the use of statins after diagnosis was associated with a decreased risk in prostate cancer mortality. However, this effect was stronger in patients who also used statins before diagnosis.

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1836 RISK ASSESSMENT: PRE-DIAGNOSTIC PREDICTORS FOR PROSTATE CANCER MORTALITY AND DISTANT METASTASIS

The Journal of Urology ◽

10.1016/j.juro.2010.02.1775 ◽

2010 ◽

Vol 183 (4S) ◽

Author(s):

Pim van Leeuwen ◽

Roderick van den Bergh ◽

Tineke Wolters ◽

Fritz Schröder ◽

Monique Roobol

Keyword(s):

Prostate Cancer ◽

Risk Assessment ◽

Distant Metastasis ◽

Cancer Mortality ◽

Prostate Cancer Mortality

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Aspirin use in prostate cancer and the risk of death and metastasis.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.1518 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 1518-1518 ◽

Cited By ~ 1

Author(s):

Jonathan Assayag ◽

Laurent Azoulay ◽

Hui Yin ◽

Michael N. Pollak ◽

Samy Suissa

Keyword(s):

Prostate Cancer ◽

Cancer Diagnosis ◽

Distant Metastasis ◽

Cancer Mortality ◽

Control Analysis ◽

Cancer Outcomes ◽

Prostate Cancer Diagnosis ◽

Prostate Cancer Mortality ◽

All Cause Mortality

1518 Background: There has been recent interest in the role of aspirin in preventing prostate cancer outcomes, but data remain limited. The objective was to determine whether the use of aspirin after prostate cancer diagnosis is associated with a decreased risk of prostate cancer mortality, distant metastasis and all-cause mortality in men newly-diagnosed with prostate cancer. Methods: A population-based cohort of men diagnosed with non-metastatic prostate cancer between 01/04/1998 and 31/12/2009 was identified using the UK Clinical Practice Research Datalink, including the Cancer Registry. All men were followed until death, distant metastasis, or 01/10/2012. A nested case-control analysis was performed where, for each case with an incident outcome event, up to 10 controls were matched on age, year of diagnosis and duration of follow-up. Exposure was defined as aspirin use during the matched follow-up period. Rate ratios (RR) and 95% confidence intervals (CI) were estimated using conditional logistic regression, adjusted for covariates and considering effect modification by aspirin use prior to prostate cancer diagnosis. Results: The cohort included 13,396 prostate cancer patients, followed for 3.9 (SD=2.4) years during which 4,425 deaths occurred, including 2,315 from prostate cancer, and 2,344 cases of distant metastasis. Aspirin use was associated with an increased risk of prostate cancer mortality (RR 1.36, 95% CI 1.18-1.55) and all-cause mortality (RR 1.33, 95% CI 1.21-1.47), but not distant metastasis (RR 1.09, 95% CI 0.94-1.27). The increased risks were limited to patients who did not use aspirin before diagnosis, for both prostate cancer mortality (RR 1.69, 95% CI 1.43-2.00) and all-cause mortality (RR 1.62, 95% CI 1.44-1.82), while those who used aspirin before diagnosis did not have increased risks (RR 0.93, 95% CI 0.76-1.15 and RR 0.98, 95% CI 0.85-1.13, respectively). Conclusions: The use of aspirin after prostate cancer diagnosis is not associated with a decreased risk of prostate cancer outcomes. Although increased risks were observed for all-cause and prostate cancer mortality, these effects were exclusively driven by new-users of aspirin, suggesting that aspirin use in these patients was likely related to disease progression.

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Postdiagnosis Statin Use and Mortality in Danish Patients With Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2016.71.8981 ◽

2017 ◽

Vol 35 (29) ◽

pp. 3290-3297 ◽

Cited By ~ 34

Author(s):

Signe Benzon Larsen ◽

Christian Dehlendorff ◽

Charlotte Skriver ◽

Susanne Oksbjerg Dalton ◽

Christina Gade Jespersen ◽

...

Keyword(s):

Prostate Cancer ◽

Cancer Mortality ◽

Clinical Stage ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Prostate Cancer Mortality ◽

All Cause Mortality ◽

Specific Mortality ◽

Cancer Specific Mortality ◽

Statin Use

Purpose Increasing evidence indicates that statin use may reduce mortality from prostate cancer. In this work, we examined whether postdiagnosis statin use was associated with reduced cancer-specific mortality or all-cause mortality among patients with prostate cancer in Denmark. Material and Methods From nationwide Danish registries, we identified all patients with incident prostate adenocarcinoma from 1998 to 2011 and retrieved data on tumor and patient characteristics, drug use, and primary treatment. We defined postdiagnosis use (two or more prescriptions) of statins as a time-varying covariate with 1-year lag. Cox proportional hazards regression models used to compute hazard ratios (HRs) for prostate cancer–specific mortality and all-cause mortality through 2013 associated with postdiagnosis statin use. In secondary and sensitivity analyses, we assessed statin use within exposure periods of 1 year or 5 years after prostate cancer diagnosis and evaluated the influence of prediagnosis statin use. Results Among 31,790 patients, 7,365 died of prostate cancer and 11,811 died from other causes during a median follow-up of 2.8 years (interquartile range, 1.3 to 5.1 years) from 1 year after diagnosis. Postdiagnosis statin use was associated with adjusted HRs of 0.83 (95% CI, 0.77 to 0.89) for prostate cancer mortality and 0.81 (95% CI, 0.76 to 0.85) for all-cause mortality. Similar results were observed in 1-year and 5-year sensitivity analyses. No substantial effect measure modification was found with estimated dose or type of statin, clinical stage, Gleason score, or with prediagnosis statin use; however, patients who were diagnosed early in the study period or who underwent radical prostatectomy or endocrine therapy exhibited slightly lower HRs for prostate cancer mortality with postdiagnosis statin use than did those in the overall analyses. Conclusion Postdiagnosis statin use was associated with reduced mortality from prostate cancer; however, it remains to be established whether this association is causal.

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