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Common painkillers lower levels of prostate cancer biomarker
By Dross at 2008-09-09 20:23
Common painkillers lower levels of prostate cancer biomarker

Common painkillers like aspirin and ibuprofen appear to lower a man's PSA level, the blood biomarker widely used by physicians to help gauge whether a man is at risk of prostate cancer.

But the authors of the study, which appears online Sept. 8 in the journal Cancer, caution that men shouldn't take the painkillers in an effort to prevent prostate cancer just yet.

"We showed that men who regularly took certain medications like aspirin and other non-steroidal anti-inflammatory drugs, or NSAIDS, had a lower serum PSA level," said first author Eric A. Singer, M.D., M.A., a urology resident at the University of Rochester Medical Center. "But there's not enough data to say that men who took the medications were less likely to get prostate cancer. This was a limited study, and we do not know how many of those men actually got prostate cancer."

Singer's team studied the records of 1319 men over the age of 40 who took part in the 2001-2002 National Health and Nutrition Examination Survey (NHANES), a health census conducted by the Centers for Disease Control and Prevention. The team looked at the men's use of NSAIDs such as aspirin and ibuprofen, as well as the painkiller acetaminophen, and at their PSA levels. A man's level of PSA, or prostate-specific antigen, is one of many clues that physicians watch to gauge a man's risk of getting prostate cancer.

The team found that men who used NSAIDs regularly had PSA levels about 10 percent lower compared to men who did not. The team made a similar observation with acetaminophen, but the result was not statistically significant due to the lower number of men in the study taking the medication.

While it might be easy to assume that a lowered PSA level automatically translates to a lowered risk of prostate cancer, the authors stress that it's too soon to draw that conclusion.

"While our results are consistent with other research that indicates that certain painkillers may reduce a man's risk of getting prostate cancer, the new findings are preliminary and don't prove a link," said corresponding author Edwin van Wijngaarden, Ph.D., assistant professor in the Department of Community and Preventive Medicine.

Singer said that a man's PSA level can be elevated for reasons unrelated to cancer. Sometimes, for instance, while inflammation is part of a cancer process, sometimes it is not, and so it's possible that a lowered PSA reflects reduced inflammation without affecting a man's risk of prostate cancer. Another possibility is that a PSA level lowered by NSAIDs might artificially mask a man's risk of getting prostate cancer: The medications might lower the PSA, but a man's risk might stay precisely the same.

"These findings underscore the importance for doctors to know what medications their patients are on," said Singer, who is chief Urology resident at the University of Rochester Medical Center. "For instance, there are medications commonly used to treat an enlarged prostate that can result in a decreased PSA, and most physicians know that. Doctors should also be asking about patients' use of NSAIDs such as aspirin and ibuprofen.

"The data is very interesting, but it will take more research to determine how to interpret the findings. In the meantime, this shouldn't change men's behavior or prompt them to take these medications to try to prevent prostate cancer."

3 comments | 1774 reads

by gdpawel on Fri, 2012-08-31 23:03
Taking a regular dose of aspirin may help men treated for prostate cancer, either with surgery or radiation, live longer, especially if they have the high risk form of the disease.

This was the finding of a new study published this week in the Journal of Clinical Oncology.

First author Kevin Choe, assistant professor of radiation oncology at University of Texas (UT) Southwestern, told the press:

"The results from this study suggest that aspirin prevents the growth of tumor cells in prostate cancer, especially in high-risk prostate cancer, for which we do not have a very good treatment currently."

There have been studies suggesting that regular aspirin or other anticoagulants can slow cancer growth and prevent it spreading. For instance, earlier this year, three studies in The Lancet added weight to the idea that for cancer, the benefits of daily aspirin probably outweigh the risks.

But clinical evidence has been limited, say Choe and colleagues.

For their multi-center study, they looked at data on nearly 6,000 men who had prostate cancer treated with surgery (prostatectomy) or radiotherapy and whose details were recorded in the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) database.

37% of the participants (about 2,200 men) were taking anticoagulants (warfarin, clopidogrel, enoxaparin, and/or aspirin).

The researchers compared the risk of death from prostate cancer between the participants taking anticoagulants and those who did not.

The results showed that the rate of death over 10 years from prostate cancer was significantly lower in the anticoagulant group than it was in the non-anticoagulant group (3% versus 8% respectively).

The risk of the cancer returning, and of it spreading to the bone was also significantly lower in the anticoagulant group.

When they analyzed a subgroup of participants according to clinical risk, the researchers found the reduction in deaths to prostate cancer was most pronounced in patients with high-risk disease (4% v 19%, respectively).

The beneficial effect was seen in both patients treated with surgery and patients treated with radiation.

And, on further analysis, the researchers found the reduction in deaths to prostate cancer was mostly due to aspirin.

They conclude that anticoagulant therapy, and aspirin in particular, is linked with a reduced risk of death from prostate cancer in men treated either with surgery or radiation therapy.

"The association was most prominent in patients with high-risk disease," they add.

However, Choe cautions that "we need to better understand the optimal use of aspirin before routinely recommending it to all prostate cancer patients".

Prostate cancer is the most common non-skin cancer in men and the second biggest cause of cancer deaths in the US.


"Aspirin Use and the Risk of Prostate Cancer Mortality in Men Treated With Prostatectomy or Radiotherapy"; Kevin S. Choe, Janet E. Cowan, June M. Chan, Peter R. Carroll, Anthony V. D'Amico, and Stanley L. Liauw; Journal of Clinical Oncology, published online 27 August 2012; DOI:10.1200/JCO.2011.41.0308

Catharine Paddock PhD. "Aspirin May Prolong Prostate Cancer Survival." Medical News Today. MediLexicon, Intl., 30 Aug. 2012

Additional source: UT Southwestern Medical Center.


by gdpawel on Fri, 2012-08-31 23:08
Richard Hoffman, M.D., MPH

Earlier this week investigators reported that men treated for localized prostate cancer who were also taking aspirin were less likely to die from prostate cancer than men who were not taking aspirin. The story garnered considerable media attention. The news reports were intriguing, but I also found two underlying themes worth considering—the concepts of patient-centered outcomes and comparative effectiveness research.

While researchers and clinicians often focus on surrogate endpoints—markers of disease progression—patients are more concerned about outcomes such as disability, hospitalization, and death. Dying from prostate cancer is certainly an important outcome—as is dying from any cause. Because aspirin is used to protect against cardiovascular disease death, inquiring readers might want to know about the non-cancer deaths.

A New York Times story quoted the lead author as saying “researchers went to great lengths to make sure that aspirin users were not experiencing fewer deaths from prostate cancer simply because they were more elderly and therefore more likely to die of other diseases before prostate cancer had progressed enough to kill them.” This is important because competing causes of death could have biased the conclusions about aspirin and prostate cancer death.

However, when I read the study, I could find only that 75% of the deaths were not caused by prostate cancer—with no indication whether overall mortality differed by aspirin status. An important omission in the quest for patient centered outcomes.

Another theme highlighted by the study is comparative effectiveness research. Research often seeks to determine the best ways to treat diseases. The most valid evidence comes from randomized controlled trials, which provide the best-of-all-worlds’ answer—highly selected patients followed closely by expert health care teams, though with relatively small numbers of patients and limited follow up duration. However, using randomized trials to answer research questions is not always feasible and results are not necessarily generalizable to clinical practice. Consequently, investigators increasingly rely on observational data, which can come from prospectively followed cohorts, registries, claims data, or electronic health records.

While observational data are easier to collect–and better reflect the messy real world of clinical care–their interpretation is subject to biases. The most important is selection bias, because people who receive one treatment versus another may differ markedly in important characteristics that are highly correlated with the outcomes of interest. Determining whether good outcomes are due to taking a drug or due to baseline differences in patient health factors is challenging. While imperfect, there are accepted statistical techniques to adjust for selection bias in observational studies. However, it did not appear that the investigators used them in their analyses.

While observational studies can often be hypothesis-generating–an aspirin benefit in cancer patients is certainly plausible–there are numerous pitfalls in performing and reporting them. Caveat lector….

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