title: The associations between statin use and prostate cancer screening, prostate size, high-grade prostatic intraepithelial neoplasia (PIN), and prostate cancer.
abstract: OBJECTIVE
  Prior studies report statins may reduce the risk of advanced prostate cancer. This study investigates the association between statin use and the likelihood of having a PSA or DRE test, blood PSA levels, prostate volume, and the severity of lower urinary tract symptoms. We also describe the association between statin use and prostate cancer and high-grade prostatic intraepithelial neoplasia (PIN) before and after controlling for prostate cancer screening indices associated with statin use.
  
  
  METHODS
  The Nashville Men's Health Study used a multicenter, rapid recruitment protocol to collect clinical, biologic, behavioral, and body measurement data from 2,148 men 40 years or older scheduled for diagnostic prostate biopsy. Medication use and other data were ascertained by research survey, clinical interview, and chart review.
  
  
  RESULTS
  Approximately 37% of participants were taking a statin. Statin use was significantly associated with a 12% lower PSA levels and 8% smaller prostate volume after controlling for age, race, BMI, WHR, aspirin use, and other comorbidity. Simvastatin was more strongly associated with prostate volume, while atorvastatin was associated with PSA. Statin use was marginally associated with increasing PSA test frequency among men with undiagnosed cancer. Statin use was not associated with the frequency or results of digital rectal exams, lower urinary tract symptom severity, high-grade (Gleason > 6) prostate cancer (OR = 0.95 (0.73, 1.24)), low-grade (Gleason = 6) prostate cancer (OR = 1.11 (0.86, 1.42)) or PIN (OR = 0.82, (0.57, 1.17)). Additional control for the number of prior PSA tests, PSA levels, and prostate volume did not alter these results.
  
  
  CONCLUSIONS
  These results suggest selective referral for biopsy associated with statin use is an essential element to address in further understanding the potential for statins to prevent prostate cancer.
authors.affiliation: Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, 2525 West End Ave. 6th Floor, Suite 600, Nashville, TN 37203-1738, USA. jay.fowke@vanderbilt.edu
authors.forename: Jay H
authors.initials: JH
authors.lastname: Fowke
authors.forename: Saundra S
authors.initials: SS
authors.lastname: Motley
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
authors.forename: Michael S
authors.initials: MS
authors.lastname: Cookson
authors.forename: Raoul
authors.initials: R
authors.lastname: Concepcion
authors.forename: Susan
authors.initials: S
authors.lastname: Byerly
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D051517:Digital Rectal Examination; D055088:Early Detection of Cancer / Q000379:methods; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011470:Prostatic Hyperplasia / Q000097:blood* / Q000209:etiology* / Q000473:pathology; D019048:Prostatic Intraepithelial Neoplasia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017430:Prostate-Specific Antigen