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Statin therapy may complicate prostate cancer detection

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After beginning statin therapy, men without prostate cancer saw PSA concentrations decrease by 4.1%, according to data published in the Journal of the National Cancer Institute.

Researchers from the Duke University Medical Center and Johns Hopkins Medical Institutions in Baltimore conducted a longitudinal study to examine the effect of statin therapy on PSA levels and the potential for prostate cancer diagnosis.

The study included 1,214 men without prostate cancer who were prescribed statin therapy between 1990 and 2006 at the Durham Veterans Affairs Medical Center. The researchers analyzed PSA levels before and after statin therapy and examined the relationship between change in PSA and change in cholesterol parameters.

Prior to statin therapy, median PSA concentration was 0.9 ng/mL and mean LDL cholesterol was 144 mg/dL. After beginning statins, LDL declined by a median of 27.5% and PSA levels by a median of 4.1% (P<.001).

The researchers found a strong correlation between PSA concentrations and statin dose and changes in LDL. After starting statin therapy, PSA levels decreased by 1.64 with every 10% decrease in LDL (P=.001). Among men with PSA levels >2.5 ng/mL prior to statin therapy (n=188), those with .41% decrease in LDL after statin therapy had a 17.4% drop in serum PSA levels.

“By lowering PSA levels, statins may complicate cancer detection, although further studies are needed to quantify the clinical significance of this effect,” the researchers wrote.

In an accompanying editorial, Ian M. Thompson, MD, and Catherine M. Tangen, DrPH, of the department of urology at the University of Texas Health Science Center, and Alan R. Kristal, DrPH, associate program head of the Cancer Prevention Faculty at Fred Hutchinson Cancer Research Center, wrote, “The most important question is whether statins might be preventive, therapeutic or simply affect PSA level itself.”

They wrote that testing statins for prevention and therapeutic interventions would be extremely difficult due to a need for a large sample size, extended follow-up and end-of-study biopsies, but analyzing whether statins affect PSA levels could be conducted using a randomized trial.

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