Statin drugs improve blood cholesterol levels, but they also cause problems. They also seem to lower the risk of prostate cancer recurrences post surgery by as much as 30% according to researchers at Duke University. These findings are published in the journal Cancer.

Stephen Freedland, M.D., a member of the Duke Prostate Center and the Urology Section at the Durham Veterans Affairs Medical Center, and the senior author of the study, said “The findings add another layer of evidence suggesting that statins may have an important role in slowing the growth and progression of prostate cancer. Previous studies have shown that statins have anti-cancer properties, but it’s not entirely clear when it’s best to use them — or even how they work.”

The researchers at Duke evaluated the records of 1319 men who underwent radical prostatectomy included in the Shared Equal Access Regional Cancer Hospital (SEARCH) database. Their analysis found that 18 percent of the men, 236 were taking statins at the time of surgery.

The men were then followed after surgery to evaluate biochemical recurrence rates, measured by slight rises in the PSA levels after surgery. Time to biochemical recurrence is viewed as an important clinical factor because it is correlated with the risk of disease progression and death.

Overall, statin use reduced the risk of biochemical recurrence by 30 percent. Three hundred and four (304) men experienced a rising PSA, including 37 (16 percent) of the statin users and 267 (25 percent) of the non-users. When the researchers took into account the various clinical and pathological features that differed between the two groups, they concluded that among the men taking statins (equivalent to 20 mg of simvastatin a day), the risk of recurrence was reduced 43 percent and among the men taking the equivalent of more than 20 mg of simvastatin a day, the risk of recurrence was reduced 50 percent. The men who took a statin dose the equivalent of less than 20 mg of simvastatin daily saw no benefit.

The clear conclusion was there is a significant difference between those who took statin drugs and those who did not take them.

The researchers also pointed out that statin users tended to be white, older and heavier than non-users. They also had lower clinical stages at diagnosis, but higher Gleason scores, a measure of tumor aggressiveness.

Robert Hamilton, M.D., a urologist at the University of Toronto and the lead author of the study said urged some prudence, “These findings are intriguing, but we do need to approach them with some caution. For example, we don’t know the diet, exercise or smoking habits of these men. So it’s not entirely clear if the lower risk we detected is related to the statins alone — it could be due to other factors we were not able to measure. We do feel, however, that based on these findings and those from other studies, the time is ripe to perform a well-controlled randomized trial to test whether statins do indeed slow prostate cancer progression.”

The study was funded by the Department of Defense, Prostate Cancer Research Program; the Department of Veterans Affairs, the National Institute of Health, the Georgia Cancer Coalition and the American Urological Association Foundation/Astellas Rising Star in Urology Award.

So, weigh carefully with your doctor the risk/reward concerns of taking statin drugs post surgery. Statins are not without risk.

Statins include well-known medications such as atorvastatin (Lipitor), simvastatin (Zocor), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and others. Lower cost generic versions of many statin medications are also available.

Although statins are well tolerated by most people, they do have side effects, some of which may go away as your body adjusts to the medication.

Common, less serious side effects:
• Muscle and joint aches (most common)
• Nausea
• Diarrhea
• Constipation

Potentially serious side effects:
• Liver damage. Occasionally, statin use causes an increase in liver enzymes that can lead to permanent liver damage.
• Muscle problems. Statins may cause muscle pain and tenderness (statin myopathy). The higher the dose of statin you take, the more likely you are to have muscle pains. In severe cases, muscle cells can break down (rhabdomyolysis) and release a protein called myoglobin into the bloodstream. Myoglobin can damage your kidneys.

Joel T Nowak, MA, MSW