title: Aspirin improves outcome in high risk prostate cancer patients treated with radiation therapy.
abstract: OBJECTIVE
  High-risk prostate cancer (PC) has poor outcomes due to therapeutic resistance to conventional treatments, which include prostatectomy, radiation, and hormone therapy. Previous studies suggest that anticoagulant (AC) use may improve treatment outcomes in PC patients. We hypothesized that AC therapy confers a freedom from biochemical failure (FFBF) and overall survival (OS) benefit when administered with radiotherapy in patients with high-risk PC.
  
  
  METHODS
  Analysis was performed on 74 high-risk PC patients who were treated with radiotherapy from 2005 to 2008 at UT Southwestern. Of these patients, 43 were on AC including aspirin (95.6%), clopidogrel (17.8%), warfarin (20%), and multiple ACs (31.1%). Associations between AC use and FFBF, OS, distant metastasis, and toxicity were analyzed.
  
  
  RESULTS
  Median follow-up was 56.6 mo for all patients. For patients taking any AC compared with no AC, there was improved FFBF at 5 years of 80% vs. 62% (P = 0.003), and for aspirin the FFBF was 84% vs. 65% (P = 0.008). Aspirin use was also associated with reduced rates of distant metastases at 5 years (12.2% vs. 26.7%, P = 0.039). On subset analysis of patients with Gleason score (GS) 9-10 histology, aspirin resulted in improved 5-year OS (88% vs. 37%, P = 0.032), which remained significant on multivariable analysis (P<0.05).
  
  
  CONCLUSIONS
  AC use was associated with a FFBF benefit in high-risk PC which translated into an OS benefit in the highest risk PC patients with GS 9-10, who are most likely to experience mortality from PC. This hypothesis-generating result suggests AC use may represent an opportunity to augment current therapy.
authors.affiliation: Department of Radiation Oncology; Harold C. Simmons Comprehensive Cancer Center; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: Corbin D
authors.initials: CD
authors.lastname: Jacobs
authors.affiliation: Department of Radiation Oncology; Harold C. Simmons Comprehensive Cancer Center; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Chun
authors.affiliation: Department of Clinical Sciences; Harold C. Simmons Comprehensive Cancer Center; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: Jingsheng
authors.initials: J
authors.lastname: Yan
authors.affiliation: Department of Clinical Sciences; Harold C. Simmons Comprehensive Cancer Center; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: Xian-Jin
authors.initials: XJ
authors.lastname: Xie
authors.affiliation: Department of Radiation Oncology; Harold C. Simmons Comprehensive Cancer Center; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Pistenmaa
authors.affiliation: Department of Radiation Oncology; Harold C. Simmons Comprehensive Cancer Center; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: Raquibul
authors.initials: R
authors.lastname: Hannan
authors.affiliation: Department of Urology; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.affiliation: Department of Urology; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: Claus G
authors.initials: CG
authors.lastname: Roehrborn
authors.affiliation: Department of Radiation Oncology; Harold C. Simmons Comprehensive Cancer Center; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Choe
authors.affiliation: Department of Radiation Oncology; Harold C. Simmons Comprehensive Cancer Center; University of Texas at Southwestern Medical Center; Dallas, TX USA.
authors.forename: D W Nathan
authors.initials: DW
authors.lastname: Kim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D059248:Chemoradiotherapy; D000077144:Clopidogrel; D004354:Drug Screening Assays, Antitumor; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000517:prevention & control; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D012306:Risk; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: anticoagulant; aspirin; prostate cancer; radiotherapy