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Statins lower PSA levels, may impair prostate cancer screening

Last Updated: 2009-12-22 17:34:09 -0400 (Reuters Health)

December 23, 2009

By Ford Vox, MD

NEW YORK (Reuters Health) - Statin drugs lower prostate specific antigen (PSA) levels by a small amount, but enough so that some men with prostate cancer might not get screening biopsies, researchers report in the January issue of the Journal of Urology.

Recently, other groups found lower PSAs in men on statins who underwent prostate cancer screening. The new study is the first to find the same effect in men known to have the disease.

The study included 3828 men with prostate cancer seen at the Henry Ford Health System in Detroit between 2001 and 2008.

Researchers compared the 1031 patients taking any kind of statin to the 2797 not on any drug in the class. They found that the median PSA in the statin-treated group was 5.0, versus 5.2 in men not taking statins (p = 0.0015). However, PSA levels were significantly lower only in men ages 50-59 and men with body mass index between 25-29.9 kg/m2.

Higher pathological Gleason sums correlated with larger differences in PSA between the groups, the investigators add. For example, in men with Gleason 7 disease, median PSA was 5.0 with statins and 5.4 without (p < 0.05). In men with Gleason 8-10 disease, median PSA dropped from 6.6 (without statins) to 6.1 (in statin-treated patients; p < 0.05).

The multivariate analysis, which controlled for these factors as well as for finasteride therapy and diabetes history, saw an overall 4.7% drop in PSA (p < 0.001).

The authors did not report the doses or duration of statin therapies due to limitations in the scope of their institutional review board approval.

"It is possible that statins could mask the PSA enough to keep people from being screened appropriately," lead author Dr. L. Spencer Krane told Reuters Health.

Dr. Krane's study also appears to further dampen early hopes that statins may help prevent prostate cancer. Statins had no impact on the rate of biochemical PSA recurrence after prostatectomy. On multivariate analysis, statins were the only factor not predictive of recurrence (unlike stage, Gleason grade, PSA and surgical margin status).

Still, the lower PSAs point to an unknown interaction between statins and the prostate gland, Dr. Krane said. "We really need to understand how statins are able to do this, whether it's an anti-inflammatory effect on the prostate or if there's a more complex interaction with the prostate cancer cells," he added.

In an accompanying editorial, Dr. Mark Garzotto of the Portland VA Medical Center in Oregon focuses on the confounding role of obesity in PSA measurement. Obesity is known to lower PSA levels through hemodilution, an effect that may be at work in the current study, where there was no difference between statin users and nonusers in the low BMI group.

Another editorialist, Dr. Robert J. Hamilton of the University of Toronto, highlights the similarity of the researchers' findings to his own (a 4.1% drop seen in a screening population). A biological rationale must emerge before a large randomized controlled trial is warranted, he writes, but in the meantime, researchers should continue to investigate the question in different populations and with different study designs. Future studies should include statin doses and cholesterol changes, he said.

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Statins lower PSA levels, may impair prostate cancer screening

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