Presentation Authors: Hanan Goldberg*, Faizan Mohsin, Zachary Klaassen, Thenappan Chandrasekar, Christopher Wallis, Jaime Omar Herrera Cáceres, Ardalan Ahmed, Dixon Woon, Shabbir Alibhai, Alejandro Berlin, Refik Saskin, Robert Hamilton, Girish Kulkarni, Neil Fleshner, Toronto, Canada
Introduction: Prostate cancer (PC) is the most common non-cutaneous cancer in Canadian men and the third most common cause of cancer death in males accounting for 10% of all male cancer deaths in Canada. Several observational and randomized studies have shown that use of commonly prescribed medications, including those used for the treatment of diabetes and hypercholesterolemia, is associated with improved survival in various malignancies, including PC. There has not been any large population-based study, examining the effects of these and other commonly prescribed medications, such as proton pump inhibitors (PPI), on the rate of PC diagnosis, over more than 20 years of follow-up.
Methods: A retrospective population-based study using data from the Institute of clinical evaluative sciences (ICES), including all male patients aged 65 and above in Ontario who have had a negative first prostate biopsy between 1994 and 2016. We assessed the impact of commonly prescribed medications on PC diagnosis. The analyzed medications included Statins (hydrophilic and hydrophobic), most commonly used diabetes drugs (metformin, insulins, sulfonylureas, and thiazolidinediones), PPIs, 5 alpha reductase inhibitors, and alpha blockers. Time-dependent Cox regression proportional hazards models were performed determine predictors of PC diagnosis. Medication exposure was time-varying and modeled as â€œeverâ€ vs. â€œneverâ€ use or as cumulative exposure.
Results: A total of 51,415 men were analyzed over a mean (SD) follow-up time of 8.06 (5.44) years. Overall, 10,466 patients (20.4%) were diagnosed with PC, 16,726 (32.5%) had died, and 1,460 (2.8%) patients died of PC. On multivariable analysis for PC diagnosis increasing age and rurality index were associated with higher PC diagnosis rate, while a more recent index year and usage of hydrophilic statins was associated with a lower diagnosis rate in both â€œeverâ€ vs. â€œneverâ€ and cumulative models (table 1).
Conclusions: Hydrophilic statins with a clinically and statistically significant lower PC diagnosis. To our knowledge, this is the first study demonstrating a clear advantage of hydrophilic over hydrophobic statins in PC prevention.
Source of Funding: This research was supported by the CUA CUOG Astellas Research Grant Program funded by Astellas Pharma Canada, Inc. and jointly established by Astellas Pharma Canada, Inc., CUOG, and the Canadian Urological Association.