title: Common medications and prostate cancer mortality: a review.
abstract: OBJECTIVE
  Most prostate cancer patients also have comorbidities that are treated with both prescription and nonprescription medications; furthermore, many use dietary supplements. We assess their association with prognosis after prostate cancer diagnosis, and we discuss methodological challenges and clinical implications.
  
  
  METHODS
  We reviewed high-quality observational studies investigating the association of commonly used medications and supplements with prostate cancer-specific mortality.
  
  
  RESULTS
  There is preliminary evidence that statins and metformin use may be associated with lower risk of cancer-specific mortality after prostate cancer diagnosis; conversely, high calcium and multivitamin supplementation may be associated with increased risk. Evidence is inconclusive for nonsteroidal anti-inflammatory drugs, acetylsalicylic acid (aspirin), insulin, antihypertensives such as angiotensin-converting enzyme inhibitors and beta-blockers, digoxin, and warfarin. Common limitations of the internal validity of studies examined include unmeasured confounding and confounding by indication, competing risks, and time-related biases such as immortal time bias. The majority of studies focused on Caucasian men with specific comorbidities, while heterogeneity among patients and tumors was mostly not assessed.
  
  
  CONCLUSIONS
  Commonly prescribed medications and over-the-counter supplements may influence prognosis among prostate cancer patients. Further well-designed pharmacoepidemiologic studies and randomized controlled trials of selected medications in appropriate patient groups are necessary before these drugs can bear new indications for prostate cancer treatment. We discuss considerations when deciding about use of these drugs in clinical practice at the present time.
authors: Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. stopsack@post.harvard.edu.
authors: Konrad H
authors: KH
authors: Stopsack
authors: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors: Alexandra J
authors: AJ
authors: Greenberg
authors: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.|Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors: Lorelei A
authors: LA
authors: Mucci
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D019587:Dietary Supplements; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000008:administration & dosage*; D064887:Observational Studies as Topic; D055553:Prescription Drugs / Q000008:administration & dosage*; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000503:physiopathology / Q000517:prevention & control*; D016019:Survival Analysis
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D004366:Nonprescription Drugs; D055553:Prescription Drugs; D008687:Metformin; D001241:Aspirin
keywords: Aspirin; Metformin; Mortality; Pharmacoepidemiology; Prostate cancer; Statins