Statins and prostate cancer

Statins have long been known to have pleiotropic effects beyond lowering LDL and decreasing cardiovascular events. They have been shown to positively modulate vascular inflammation and biomarkers of atherosclerosis. More recently, statins have been evaluated for potential non-cardiovascular benefits.

Journal of the National Cancer InstituteA study in the found that men who were prescribed a statin had a small but statistically significant difference in PSA. The reduction in PSA was associated with the lowering of LDL. For every 10% decrease in LDL, PSA decreased by 1.64 ng/mL. After initiating a statin, LDL decreased by 27.5% and PSA by 4.1% (P<0.001). The authors suggested that because of this PSA-lowering effect, statin therapy could possibly affect the detection of prostate cancer.

The question is: might statins play any role in the prevention or treatment of prostate cancer?

Statins inhibit HMG-CoA reductase, an enzyme early in the synthetic pathway of cholesterol. By doing so, they also reduce levels of isoprenoids and other compounds. Isoprenoids play a role in cell growth and proliferation, and are thought to be important in the cellular signaling of prostate cancer. In addition, the anti-angiogenic and anti-inflammatory effects of statins might theoretically prevent cancer development and progression.

It was once thought that statins could lower serum levels of testosterone and other steroid hormones. However, this has never been confirmed by subsequent research. Nevertheless, it may be possible that statins lower intracellular testosterone levels of prostate and other cells. If that occurs, that would be another mechanism where statins could lower PSA and prostate cancer risk.

Several other studies have investigated the effects of statins upon prostate cancer. Thus far, results have been inconclusive. Early studies suggested lower overall incidence of prostate cancer, but this was not confirmed on later studies and meta-analyses. Although the risk of overall prostate cancer does not appear to be affected by statin therapy, there have been some studies suggesting that statins may reduce the risk of advanced prostate cancer. Other investigators have found that statin use significantly increases PSA-free survival and decreases distant metastasis in prostate cancer patients receiving other treatments such as radiotherapy.

Although these results are encouraging, more study is needed to confirm whether statins play a direct role in the development and progression of prostate cancer. Statins are the foundation of lipid-lowering therapy and cardiovascular prevention in many patients; it will be interesting if other beneficial uses are discovered in the future.

J Natl Cancer Inst. 2008;100:1511-1518.

Curr Opin Urol. 2008, 18:333-339.