title: Statins and Metformin Use Is Associated with Lower PSA Levels in Prostate Cancer Patients Presenting for Radiation Therapy.
abstract: BACKGROUND
  A possible association between the level of prostate specific antigen (PSA) and the use of some commonly prescribed medications has been reported in recent studies. Most of these studies were carried out in general populations of men who were screened for prostate cancer using the PSA test. We reported on the association between the initial PSA level and the use of statins, metformin and alpha-blockers in patients who were diagnosed with prostate cancer and presented for radiation therapy.
  
  
  METHODS
  Three hundred and eighty one patients treated between the years of 2000-2005 and 2009-2012 were included in this retrospective study. The information about statin, metformin and alpha-blockers use was recorded immediately prior to treatment. Differences in PSA levels prior to treatment by medication status were estimated using univa-riate and multivariate linear regression on log PSA values.
  
  
  RESULTS
  Compared with men who were not on these medications, the PSA level at presentation was 20% lower for statin users (p = 0.002) and 33% lower for metformin users (p = 0.004). We did not observe statistically significant associations between the use of statins or metformin and cancer stage, National Comprehensive Cancer Network (NCCN) risk score, or therapy outcome. A statistically significant association between the NCCN risk score and the use of alpha-blockers was observed (p = 0.002).
  
  
  CONCLUSIONS
  We found that statins and metformin were associated with lower PSA levels in prostate cancer patients to an extent that could influence management decisions. We found no statistically significant associations between the use of these medications and treatment outcomes.
authors.affiliation: School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, AZ, USA.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Liu
authors.affiliation: School of Computing, Informatics, Decision Systems Engineering, Arizona State University, Tempe, AZ, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Schild
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: William
authors.initials: W
authors.lastname: Wong
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Sujay
authors.initials: S
authors.lastname: Vora
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, AZ, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Herman
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, USA.
authors.forename: Mirek
authors.initials: M
authors.lastname: Fatyga
keywords: Metformin; PSA; Prostate Cancer; Statins