Medical Reading

Associations Of Aspirin, NSAID And Paracetamol Use With PSA-detected Prostate Cancer: Findings From A Large, Population-based, Case-control Study

September 27, 2017

UroToday - In the online edition of the International Journal of Cancer, Dr. Ali Murad and colleagues report that non-steroidal anti-inflammatory drugs (NSAIDs) do not decrease the risk of PSA-detected prostate cancer (CaP). The premises for the study are reports that cyclooxygenase-2 is an enzyme that facilitates inflammation and is overexpressed in CaP. Both aspirin (ASA) and NSAIDs inhibit cycloozygenase-2 and their use is associated with decreased risk of other cancers.

This study is a large, population-based, case-control study that is nested in cross-section within the case-finding phase of the Prostate testing for cancer and Treatment (ProtecT) trial. The associations of ASA and NSAIDs with CaP were controlled for by assessing paracetamol, an analgesic that does not influence cylooxygenase-2 nor is it associated with CaP risk.

The ProtecT study includes 110,000 men enrolled between 2001 and 2008 who were identified with CaP by PSA or abnormal DRE. Its purpose is to evaluate the efficacy, cost-effectiveness and acceptability of different treatments for localized CaP. It is multi-center and randomized. The study cohort used in this report includes men who completed a questionnaire regarding diet, lifestyle and health. Men without CaP after screening served as controls. Data on ASA, NSAIDs and paracetamol use were obtained from patient completed data surveys. The final study population was 1,016 cases and 5,043 controls. Cases were 2.6 months older than controls and more likely to have a family history of CaP. ASA was used as an antithrombotic agent by 97% of users, and NSAIDs were used for their anti-inflammatory and anti-rheumatic effects by 100% of users. ASA, NSAIDs and paracetamol were each associated with a reduction in PSA concentration among controls.

NSAIDs were associated with an increased risk of CaP (odds ratio 1.24 in the adjusted model) while statistically insignificant positive associations for ASA and paracetamol with CaP were noted. The authors point out that these positive findings are unlikely to be due to PSA-based detection bias since ASA, NSAIDs and paracetamol use were each associated with a reduction in PSA concentration.

Murad AS, Down L, Smith GD, Donovan JL, Lane JA, Hamdy FC, Neal DE, Martin RM
Int J Cancer. 2010 May 20. Epub ahead of print.
doi: 10.1002/ijc.25465

UroToday Contributing Editor Christopher P. Evans, MD, FACS

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