title: The impact of the use of aspirin and other nonsteroidal anti-inflammatory drugs on the risk of prostate cancer detection on biopsy.
abstract: OBJECTIVE
  To evaluate the association between nonsteroidal anti-inflammatory drug (NSAID) use and the risk of prostate cancer (PC) detection in men undergoing biopsy.
  
  
  METHODS
  Men were identified using our academic institution's prospectively maintained prostate biopsy database. Patients were classified as aspirin (ASA) users, users of other NSAIDs, or nonusers. The primary outcome was any PC on biopsy, and the secondary outcome was clinically significant PC (CSPC; Gleason sum ≥7). Multivariate logistic regression analyses were performed to adjust for a priori defined clinical confounders.
  
  
  RESULTS
  Of 839 patients, 408 (48.6%) were diagnosed with PC and 201 (24.0%) had CSPC. A higher proportion of ASA users (63.5%) and other NSAID users (61.2%) had PC compared with nonusers (41.9%; P <.001). CSPC was more common among ASA users (34.9%; P <.001) compared with other NSAID users (20.0%) and nonusers (20.9%). In multivariate regression analyses, ASA use (odds ratio [OR] = 2.04; 95% confidence interval [CI] = 1.32-3.13; P = .001) and other NSAID use (OR = 2.42; 95% CI = 1.36-431; P = .003) were associated with higher odds of PC detection, whereas ASA use was associated with higher odds of CSPC (OR = 1.62; 95% CI = 1.00-2.62; P = .048).
  
  
  CONCLUSIONS
  In men undergoing biopsy, ASA and other NSAID use were associated with increased probability of detecting PC, whereas ASA use was associated with the risk of detecting CSPC. Although NSAID use might have a protective biological effect against PC, men who develop elevated prostate-specific antigen levels while on NSAIDs may nonetheless be less likely to have an inflammatory etiology and more likely to harbor PC. It may be warranted for clinicians to consider the influence of NSAIDs when evaluating patients being considered for biopsy.
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: bimal.bhindi@mail.utoronto.ca.
authors.forename: Bimal
authors.initials: B
authors.lastname: Bhindi
authors.affiliation: Division of Urology and Davidoff Cancer Center, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Margel
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Hamilton
authors.affiliation: Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Fernandes
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Greg
authors.initials: G
authors.lastname: Trottier
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Hersey
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Trachtenberg
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Zlotta
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Girish S
authors.initials: GS
authors.lastname: Kulkarni
authors.affiliation: Department of Medical Imaging, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ants
authors.initials: A
authors.lastname: Toi
authors.affiliation: Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Evans
authors.affiliation: Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Theodorus H
authors.initials: TH
authors.lastname: van der Kwast
authors.affiliation: Division of Urology, Department of Surgery, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Fleshner
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D001706:Biopsy; D016208:Databases, Factual; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000473:pathology; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D017430:Prostate-Specific Antigen; D001241:Aspirin