Presentation Authors: Tariq A. Khemees*, Jinn-ing Liou, E. Jason Abel, Tracy M. Downs, Tudor Borza, David F. Jarrard, Kyle A. Richards, Madison, WI
Introduction: There is a growing body of evidence suggesting possible therapeutic role of statin medications on advanced prostate cancer outcomes. However, little is known regarding the impact of the type of statin medications used, the dose of statins received, or the duration of treatment with this class of medications on PCa outcomes. Our goal was to investigate the impact of the statin type, dose and duration on oncologic outcomes in patients with advanced prostate cancer who are treated with androgen deprivation therapy (ADT).
Methods: We used the national VA database to identify all men diagnosed with PCa who are receiving ADT and were treated with statin medications for at least 6 months after PCa diagnosis between 2000 and 2008 with follow-up through May 2016. Patients were then stratified based on the type of statins (hydrophilic vs. lipophilic), the cumulative dose of statins (based on WHO defined daily dose for each statin medication), and the total duration of statins use ( < 12 months, 12-24 months, 24-36 months, and â‰¥ 36 months). Multivariable Cox proportional hazards analyses were performed to assess the association between cumulative duration, dose, and type of statin used and prostate cancer specific survival (PCSS), overall survival (OS) and skeletal related events (SREs).
Results: A total of 53,582 PCa patients on ADT were included in the study cohort. The median patient age was 74 years and majority (65.7%) were Caucasian. Seventy-five percent of patients had Charlson co-morbidity index of â‰¤1. The median PSA at time of diagnosis was 9.6 ng/dl. On multivariable Cox proportional hazards analysis controlling for multiple baseline characteristics, increased duration > 36 months (HR 0.48, 95% CI 0.46-0.51) and cumulative dose (HR 0.50, 95% CI 0.48-0.53) were associated with improved OS. Similar associations were noted for PCSS and SREs. Use of hydrophilic statins was associated with improved OS (HR 0.81, 95% CI 0.71-0.92) and SREs (HR 0.58, 95% CI 0.36-0.94), but was not associated with PCSS (HR 0.91, 95% CI 0.68-1.22) on Cox proportional hazards multivariable analyses.
Conclusions: Our results suggest that there is a dose response relationship between the dose, duration and type of statin used in patients with advanced prostate cancer who are treated with ADT. Patients who used higher dose of hydrophilic statins for a longer period of time have improved oncological outcomes. Statins are safe, low-cost medication with minimal side effects and can further be studied in clinical trial setting in combination with ADT.
Source of Funding: Funded by Urology Care Foundation/ AUA Research Scholar Award (T.K.)