EURURO Vol. 72 No. 5

Prostate Cancer

[2_TD$DIFF]

Regular Aspirin Use and the Risk of Lethal Prostate Cancer

in the Physicians’ Health Study

Mary K. Downer

a , b , c , y , * ,

Christopher B. Allard

d , e , y

, Mark A. Preston

d ,

J. Michael Gaziano

a , f ,

Meir J. Stampfer

a , b , c , f ,

Lorelei A. Mucci

a , c ,

Julie L. Batista

a , b , c

Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA;

Department of Nutrition, Harvard T.H. Chan School of Public

Health, Boston, MA, USA;

Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School,

Boston, MA, USA;

Division of Urology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA;

Department of Surgery, Joseph Brant

Memorial Hospital, Burlington, ON, Canada;

Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical

School, Boston, MA, USA

E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 8 2 1 – 8 2 7

ava ilable at

www.sciencedirect.com

journal homepage:

www.eu ropeanurology.com

Article info

Article history:

Accepted January 24, 2017

Associate Editor:

Matthew Cooperberg

Keywords:

Aspirin

Lethal prostate cancer

Prostate cancer mortality

Prostate cancer progression

Abstract

Background:

Regular aspirin use probably protects against some malignancies including

prostate cancer (PC), but its impact on lethal PC is particularly unclear.

Objective:

To investigate the association between regular aspirin and (1) the risk of lethal

PC in a large prospective cohort and (2) survival after PC diagnosis.

Design, setting, and participants:

In 1981/82, the Physicians’ Health Study randomized

22 071 healthy male physicians to aspirin,

-carotene, both, or placebo. After the trial

ended in 1988, annual questionnaires have obtained data on aspirin use, cancer diagnoses,

and outcomes up to 2009 for the whole cohort, and to 2015 for PC patients.

Outcome measurements and statistical analysis:

We evaluated the relationship between

regular aspirin (

3 tablets/week) and lethal PC (metastases or PC death). Cox proportional-

hazards models estimated hazard ratios (HRs) for the risk of lethal PC in the whole cohort

and postdiagnosis survival among men initially diagnosed with nonlethal PC.

Results and limitations:

Risk analysis revealed that 502 men developed lethal PC by

2009. Current and past regular aspirin was associated with a lower risk of lethal PC

(current: HR 0.68, 95% confidence interval [CI] 0.52–0.89; past: HR 0.54, 95% CI 0.40–0.74)

compared to never users. In the survival analysis, 407/3277 men diagnosed with nonlethal

PC developed lethal disease by 2015. Current postdiagnostic aspirin was associated with

lower risks of lethal PC (HR 0.68, 95% CI 0.52–0.90) and overall mortality (HR 0.72, 95% CI

0.61–0.9). We could not assess aspirin dose, and inconsistencies were observed in some

sensitivity analyses.

Conclusions:

Current regular aspirin use was associated with a lower risk of lethal PC

among all participants. Current postdiagnostic use was associated with improved survival

after diagnosis, consistent with a potential inhibitory effect of aspirin on PC progression. A

randomized trial is warranted to confirm or refute these findings.

Patient summary:

We examined the potential effect of regular aspirin use on lethal

prostate cancer. We found that taking aspirin was associated with a lower risk of lethal

prostate cancer, and taking it after diagnosis may help to prevent prostate cancer from

becoming fatal.

These authors share joint first authorship.

* Corresponding authors. Channing Division of Network Medicine, Department of Medicine, Brigham

and Women’s Hospital and Harvard Medical School, 181 Longwood Avenue, Boston, MA 02215, USA.

Tel. +1 206 2288067.

E-mail addresses:

mkd690@mail.harvard.edu

(M.K. Downer),

stampfer@hsph.harvard.edu

(M.J. Stampfer).

http://dx.doi.org/10.1016/j.eururo.2017.01.044

0302-2838/