title: Statins and prostate cancer recurrence following radical prostatectomy or radiotherapy: a systematic review and meta-analysis.
abstract: BACKGROUND
  In this meta-analysis, we evaluated associations between statins and recurrence-free survival (RFS) following treatment of localized prostate cancer, with attention to potential benefits among patients treated primarily with radiotherapy (RT) versus radical prostatectomy.
  
  
  METHODS
  We identified original studies examining the effect of statins on men who received definitive treatment of localized prostate cancer using a systematic search of the PubMed and EMBASE databases through August 2012. Our search yielded 17 eligible studies from 794 references; 13 studies with hazard ratios (HRs) for RFS were included in the formal meta-analysis.
  
  
  RESULTS
  Overall, statins did not affect RFS (HR 0.90, 95% CI 0.74-1.08). However, in RT patients (six studies), statins were associated with a statistically significant improvement in RFS (HR 0.68; 95% CI 0.49-0.93); this benefit was not observed in radical prostatectomy patients (seven studies). Sensitivity analyses suggested that primary treatment modality may impact the effect of statins on prostate cancer recurrence.
  
  
  CONCLUSIONS
  Our meta-analysis suggests a potentially beneficial effect of statins on prostate cancer patients treated with RT but not among radical prostatectomy patients. Although limited by the lack of randomized data, these results suggest that primary treatment modality should be considered in future studies examining associations between statins and oncologic outcomes.
authors.affiliation: Department of Epidemiology, Harvard School of Public Health, Boston, USA. hpark2@bidmc.harvard.edu
authors.forename: H S
authors.initials: HS
authors.lastname: Park
authors.forename: J D
authors.initials: JD
authors.lastname: Schoenfeld
authors.forename: R B
authors.initials: RB
authors.lastname: Mailhot
authors.forename: M
authors.initials: M
authors.lastname: Shive
authors.forename: R I
authors.initials: RI
authors.lastname: Hartman
authors.forename: R
authors.initials: R
authors.lastname: Ogembo
authors.forename: L A
authors.initials: LA
authors.lastname: Mucci
mesh_terms: D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000188:drug therapy*; D011468:Prostatectomy / Q000639:trends*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: meta-analysis; prostate cancer; radical prostatectomy; radiotherapy; recurrence; statin