Outcomes of Screening for Prostate Cancer Among Men Who Use Statins.


Journal

JAMA oncology
ISSN: 2374-2445
Titre abrégé: JAMA Oncol
Pays: United States
ID NLM: 101652861

Informations de publication

Date de publication:
01 Jan 2022
Historique:
pubmed: 25 11 2021
medline: 15 3 2022
entrez: 24 11 2021
Statut: ppublish

Résumé

Prostate-specific antigen (PSA) screening for prostate cancer has resulted in a slight reduction in prostate cancer mortality but also a concomitant overdiagnosis of low-risk tumors. Prostate-specific antigen levels are affected by use of cholesterol-lowering statin drugs, but the association of statin use with PSA screening performance is unknown. To investigate whether statin use was associated with outcomes of a randomized PSA-based prostate cancer screening intervention. This post hoc subgroup analysis of a cohort from a population-based randomized clinical trial used data from the population-based Finnish Randomized Study of Prostate Cancer Screening, which randomized men to PSA screening or routine care from March 1, 1996, to December 31, 1999, with follow-up continuing until December 31, 2015. The population included all men aged 55 to 67 years at baseline and residing in the Tampere or Helsinki districts of Finland. Information on statin purchases from 1996 to 2009 was obtained from a national prescription registry. Eligible men were identified from the population registry of Finland. Prevalent prostate cancer cases at baseline were excluded. Data were analyzed from January 1, 2019 to March 31, 2021. Three invitations for PSA screening at 4-year intervals from 1996 to 2007 vs routine care. Risk for prostate cancer overall, high-risk disease, and prostate cancer mortality in the screening group vs the control group as an intention-to-treat analysis. The analysis was stratified by statin use. The study comprised 78 606 men (median age, 59 years [range, 55-67 years]) with statin purchase data available. Although PSA screening was associated with increased prostate cancer incidence among statin nonusers (screening vs control, 11.2 vs 8.6 per 1000 person-years); rate ratio [RR], 1.31; 95% CI, 1.24-1.38), no similar increase in incidence was observed among statin users (6.9 vs 5.9 per 1000 person-years; RR, 1.02; 95% CI, 0.95-1.10; P < .001 for interaction). Incidence of low-risk (Gleason score 6) and localized tumors was lower among statin users, whereas detection of tumors with a Gleason score of 8 to 10 was similar. Screening was associated with a lower incidence of metastatic tumors regardless of statin use. In this post hoc subgroup analysis of a cohort from a population-based randomized clinical trial, PSA screening among statin users was associated with a decreased incidence of advanced prostate cancer that was similar among statin nonusers, but with less increase in detection of low-grade localized tumors in statin users than in nonusers. These findings suggest that statin use does not materially compromise benefits of PSA-based screening.

Identifiants

pubmed: 34817559
pii: 2786538
doi: 10.1001/jamaoncol.2021.5672
pmc: PMC8777566
doi:

Substances chimiques

Hydroxymethylglutaryl-CoA Reductase Inhibitors 0
Prostate-Specific Antigen EC 3.4.21.77

Types de publication

Journal Article Randomized Controlled Trial Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

61-68

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Auteurs

Arla Vettenranta (A)

Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.

Teemu J Murtola (TJ)

Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
Tays Cancer Centre, Department of Urology, Tampere, Finland.

Jani Raitanen (J)

Tampere University, Faculty of Social Sciences, Tampere, Finland.
Urho Kaleva Kekkonen Institute for Health Promotion Research, Tampere, Finland.

Paavo Raittinen (P)

Aalto University, Department of Mathematics and Systems Analysis, Helsinki, Finland.

Kirsi Talala (K)

Finnish Cancer Registry, Helsinki, Finland.

Kimmo Taari (K)

Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Ulf-Håkan Stenman (UH)

Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Clinical Chemistry, University of Helsinki, Helsinki, Finland.

Teuvo L J Tammela (TLJ)

Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
Tays Cancer Centre, Department of Urology, Tampere, Finland.

Anssi Auvinen (A)

Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
Tampere University, Faculty of Social Sciences, Tampere, Finland.

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