The risk of prostate cancer for men on aspirin, statin or antidiabetic medications.
BACKGROUND
A decreased risk of prostate cancer (PCa) has been suggested in men taking aspirin, statins and metformin, although the evidence has been conflicting. We estimated the association between prescribed medications, prostate specific antigen (PSA) levels and the risk of either any PCa or high-grade PCa.


METHODS
This population-based cohort study included 185,667 men having a first recorded PSA test and 18,574 men having a first prostate biopsy in Stockholm County, Sweden for the period 2007-2012. Detailed clinical information including PSA levels, biopsy results, comorbidities and educational level were obtained from population-based registers. High-grade prostate cancer was defined as a Gleason score of seven or higher. Differences in PSA levels by medication status were estimated using linear regression on log PSA values. PCa risk was estimated using multivariate logistic regression.


RESULTS
Compared with men who were not on medication, the PSA level at the first PSA test was lower among men using 75 mg/dose aspirin (-3.9% change in PSA concentration; 95% confidence interval (CI): -5.8 to -2.1), statin (-4.6%; 95% CI: -6.2 to -2.9), metformin (-14%; 95% CI: -17 to -12) and insulin (-16%; 95% CI: -18 to -14). Men using any statins had an increased risk of both high-grade PCa (odds ratio (OR) 1.25; 95% CI: 1.10-1.42) and PCa of any grade (OR 1.16; 95% CI 1.04-1.29). There were no significant associations between aspirin or any antidiabetic medication and the risk of PCa.


CONCLUSIONS
We found no protective effect of aspirin, statins or antidiabetics in terms of risk for any PCa or high-grade PCa. Use of any statins was associated with an elevated risk of being diagnosed with high-grade prostate cancer.
Department of Clinical Sciences at Danderyd's Hospital, Karolinska Institutet, S-182 88 Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-171 77 Stockholm, Sweden. Electronic address: tobias.nordstrom@ki.se.
Tobias
T
Nordström
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-171 77 Stockholm, Sweden.
Mark
M
Clements
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-171 77 Stockholm, Sweden.
Robert
R
Karlsson
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, S-171 77 Stockholm, Sweden.
Jan
J
Adolfsson
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, S-171 77 Stockholm, Sweden.
Henrik
H
Grönberg
D001241:Aspirin / Q000008:administration & dosage*; D015331:Cohort Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage*; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; D008687:Metformin; D001241:Aspirin
Chemoprevention; Prostate neoplasia; Prostate-specific antigen