*For medical professionals only
Professor Zhu Yao takes you to the latest article of JAMA Oncol.
Recently, JAMA Oncology, one of the top oncology journals, published a study with the theme of "Outcomes of Screening for Prostate Cancer Among Men Who Use Statins", and the "Medical Oncology Channel" invited Professor Zhu Yao of fudan university affiliated cancer hospital to share this research and interpret the results from a clinical practical perspective. For the majority of doctors and patients online "grounded" clinical dry goods.
Screening is thought to favor early detection of cancer and reduced mortality, but systematic screening for prostate cancer only modestly reduces prostate cancer mortality, but leads to overdiagnosis of low-risk tumors. At present, European clinically believes that prostate cancer system screening based on prostate specific antigen (PSA) brings more harm than benefits, resulting in unnecessary diagnosis of clinically significant cancers.
Statins may lower PSA levels by reducing inflammation in the prostate or inhibiting androgen signaling, and several studies have observed lower PSA levels in statin users, leading to the conjecture of whether statins can reduce PSA-based prostate cancer screening overdiagnosis. But at the same time, whether statin lowering PSA levels may lead to prostate cancer being diagnosed at a later stage, and it is still unknown whether the best time to intervene is missed.
In this context, the study, published by JAMA Oncology, investigated the correlation between PSA-based screening for statin users and non-users in prostate cancer incidence and mortality.
Medical Community: Can you briefly tell us about the findings of this study?
Professor Zhu Yao: The reason why statins are considered to be related to prostate cancer is because the source of androgens is cholesterol, and statins have a strong regulatory effect on cholesterol, so clinicians have the conjecture that statins may affect the occurrence and development of prostate cancer, and then carry out related research.
The study, published by JAMA Oncology, confirmed that PSA screening in patients taking statins provides normal benefits (detection of high-risk prostate cancer) and does not significantly increase the detection of low-risk prostate cancer, thereby reducing overexploitation of low-risk prostate cancer.
In addition, studies have suggested that statin use reduces the recurrence rate of prostate cancer. I think the rationale behind this may not be by affecting PSA levels, but by potentially androgen suppression or alleviation of inflammation. Notably, these studies are all correlation studies, and the true link between statins and prostate cancer still needs to be confirmed by prospective clinical trials.
Medical community: What other factors may affect the accuracy of PSA testing or PSA levels?
Professor Zhu Yao: In fact, "affecting the accuracy of PSA testing" and "affecting the level of PSA" are two different issues. PSA is a specific antigen secreted by the prostate, and the accuracy of PSA testing is affected by some other basic characteristics of men, in addition to prostate-related factors.
Factors that affect the accuracy of PSA detection include:
Obesity: Some past studies have suggested that obesity can affect the accuracy of PSA testing, meaning that the same level of PSA is "diluted" in obese men, resulting in lower PSA levels than actually shown on PSA testing.
Alcohol consumption and sexual behavior: Drinking alcohol and sex on the day before the PSA test will make the prostate congestion, causing excessive secretion of PSA, which will affect the accuracy of the PSA test.
Statins may affect PSA levels and are a subtle effect. In addition to the lipid-lowering effect of statins, they also have a certain effect on reducing inflammation. Both this study and previous related studies have suggested that statins may reduce PSA levels by relieving inflammation in the prostate, i.e., drugs with anti-inflammatory effects may lower PSA levels, but this conclusion needs to be confirmed by more research. In addition, finasterides can affect the secretion of PSA in men, reducing PSA levels from the source.
Medical community: Why do some prostate cancer patients with communionary disease have a better prognosis than the average patient? Based on the conclusions of this study, how should tumor patients be treated for chronic diseases?
Professor Zhu Yao: This is a very interesting phenomenon in medicine, called "reaction situation". Compared with other tumor patients, many patients with chronic diseases may have a situation that is contrary to intuition in terms of tumor survival or incidence (better than patients with non-chronic disease tumors), which has the following reasons.
First, patients with chronic diseases undergo more frequent physical examinations and tumor screening, so it is likely that they will be detected earlier in the tumor or at a later stage of recurrence, which is the advantage of regular examination.
Second, chronic diseases are often associated with obesity, and many clinical studies have found that the degree of malignancy of prostate cancer in obese prostate cancer patients is often lower than that of other causative factors (such as genetically related prostate cancer), and its occurrence and progression are more slow.
"In terms of specific clinical practice, we recommend continuing to take them normally for elderly patients with chronic diseases who are already using statins or other drugs to control blood pressure and blood sugar; but for patients with non-chronic diseases, I personally believe that the deliberate use of these drugs to reduce the recurrence rate and incidence of tumors is not sufficient." Professor Zhu Yao said.
Medical community: What is the significance and enlightenment of this study for the diagnosis and treatment of adenocarcinoma?
Prof. Yao Zhu: First of all, for the large population taking statins, the probability of overdiagnosis caused by PSA-based screening is relatively low, and the study confirmed the safety of PSA testing in people taking statins.
Second, the study opens the window for prospective research on whether the use of statins or other drugs may have a better preventive effect on prostate cancer. In the future, in larger-scale prospective studies, it is possible to explore whether other drugs such as statins and finabolics can reduce the incidence and recurrence rate of prostate cancer, so that clinicians and patients can confirm the correlation between the two and more confidently implement them at the application level.
Expert reviews essential
The study confirmed that patients taking statins benefited normally from PSA screening (detection of high-risk prostate cancer) while reducing overexploitation of low-risk prostate cancer.
Statins and other drugs that have an inflammatory effect may indirectly improve tumor incidence and recurrence rates by relieving inflammation, but this conclusion still needs to be confirmed by prospective studies.
For patients with non-chronic disease, the deliberate use of statins to reduce overdiagnosis, tumor incidence, and recurrence rates is not sufficiently evidenced.
Expert Profiles
Professor Zhu Yao
Chief Physician of Fudan University Affiliated Cancer Hospital, Doctoral Supervisor
Deputy Director of Urology, Affiliated Cancer Hospital of Fudan University
Secretary General of prostate cancer expert committee of Chinese Society of Clinical Oncology
Vice Chairman of the Youth Council of Shanghai Anti-Cancer Association
2019 Fudan University Youth May Fourth Medal
Winner of the May Fourth Medal of The Shanghai Municipal Health Commission
Selected as the outstanding young medical talent of the 2018 Shanghai "Medical Garden Rising Star"
He was selected as one of the Top Ten Medical Youth of the 7th Fudan University
It was selected into the third batch of Fudan University Zhuoxue Talent Program
Selected for the 2015 Shanghai Youth Science and Technology Rising Star Program
He serves on the editorial board of Prostate Cancer and Prostatic Disease and is a national nature review expert
As the second completer, he won the first prize of Shanghai Science and Technology Progress Award
Representative papers have been published in authoritative journals such as European Urology and Clinical Cancer Research
bibliography:
[1] Vettenranta A,et al. Outcomes of Screening for Prostate Cancer Among Men Who Use Statins.JAMA Oncol.2021 Nov 24.doi:10.1001/jamaoncol.2021.5672.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2786538
Source: Medical Oncology Channel
Editor-in-charge: Tian Dongliang
Proofreader: Zang Hengjia
Plate making: Xue Jiao