Introduction: We assessed the pathological characteristics of the radical prostatectomy specimen, the rate of biochemical failure and the functional outcome after surgery, in terms of incontinence and erectile dysfunction rate, in patients on statin medication. Materials and Methods: A total of 588 patients with a mean age 65.2 years (SD = 5.7 years) participated in the study. All patients were contacted and interviewed. Results: Users who had been on statin medication for more than 2 years had lower levels of preoperative serum PSA (p = 0.034), a 2.76 times greater likelihood of being staged as pT3a to pT3b rather than pT2a to pT2c, and a 5.39 times greater likelihood of having a postoperative Gleason score equal to seven or more. Positive surgical margins and urinary incontinence were not significantly associated with statin use. The probability of erectile dysfunction was significantly greater for statin users. Conclusion: Statin medication was associated with a statistically significantly lower PSA value and an increased rate of high Gleason score and pathologic stage in patients receiving medication for more than 2 years. Statins were found to be an independent predictor of recurrence. Lastly, statin users were more likely to present with preoperative and postoperative erectile dysfunction.

Keywords:
Statins, Prostate cancer, Radical prostatectomy, Pathological characteristics, Biochemical recurrence, Functional outcome
1.
Baigent C, Keech A, Kearney PM, et al: Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-1278.
2.
Kashani A, Phillips CO, Foody JM, et al: Risks associated with statin therapy: a systematic overview of randomized clinical trials. Circulation 2006;114:2788-2797.
3.
Knopp RH: Drug treatment of lipid disorders. N Engl J Med 1999;341:498-511.
4.
Papadopoulos G, Delakas D, Nakopoulou L, et al: Statins and prostate cancer: Molecular and clinical aspects. Eur J Cancer 2011;47:819-830.
5.
Parikh A, Childress C, Deitrick K: Statin-induced autophagy by inhibition of geranylgeranyl biosynthesis in prostate cancer PC3 cells. Prostate 2010;70:971-981.
6.
Rao S, Porter DC, Chen X, et al: Lovastatin-mediated G1 arrest is through inhibition of the proteasome, independent of hydroxymethyl glutaryl-CoA reductase. Proc Natl Acad Sci USA 1999;96:7797-7802.
7.
Nubel T, Dippold W, Kleinert H, et al: Lovastatin inhibits Rho-regulated expression of E-selectin by TNFalpha and attenuates tumor cell adhesion. FASEB J 2004;18:140-142.
8.
Freeman MR, Solomon KR: Cholesterol and prostate cancer. J Cell Biochem 2004;91:54-69.
9.
Yokomizo A, Shiota M, Kashiwagi E, et al: Statins reduce the androgen sensitivity and cell proliferation by decreasing the androgen receptor protein in prostate cancer cells. Prostate 2011;71:298-304.
10.
Hamilton RJ, Goldberg KC, Platz EA, et al: The influence of statin medications on prostate-specific antigen levels. J Natl Cancer Inst 2008;100:1511-1518.
11.
Spencer Krane L, Kaul SA, Stricker HJ, et al: Men presenting for radical prostatectomy on preoperative statin therapy have reduced serum prostate specific antigen. J Urol 2010;183:118-124.
12.
Mener DJ, Cambio A, Stoddard DG, et al: The impact of HMG-CoA reductase therapy on serum PSA. Prostate 2010;70:608-615.
13.
Newman TB, Hulley SB: Carcinogenicity of lipid-lowering drugs. JAMA 1996;275:55-60.
14.
Murtola TJ, Tammela TLV, Lahtela J, et al: Cholesterol-lowering drugs and prostate cancer risk: a population-based case-control study. Cancer Epidemiol Biomarkers Prev 2007;16:2226-2232.
15.
Ford I, Murray H, Packard CJ, et al: Long-term follow-up of the west of Scotland Coronary Prevention Study. N Engl J Med 2007;357:1477-1486.
16.
Roddam AW, Allen NE, Appleby P, et al: Endogenous sex hormones and prostate cancer: a collaborative analysis of 18 prospective studies. J Natl Cancer Inst 2008;100:170-183.
17.
Murtola TJ, Syvälä H, Pennanen P, et al: Comparative effects of high and low-dose simvastatin on prostate epithelial cells: the role of LDL. Eur J Pharmacol 2011;673:96-100.
18.
Mondul AM, Weinstein SJ, Virtamo J, et al: Serum total and HDL cholesterol and risk of prostate cancer. Cancer Causes Control 2011;22:1545-1552.
19.
Tan N, Klein EA, Li J, et al: Statin use and risk of prostate cancer in a population of men who underwent biopsy. J Urol 2011;186:86-90.
20.
Mondul AM, Han M, Humphreys EB, et al: Association of statin use with pathological tumor characteristics and prostate cancer recurrence after surgery. J Urol 2011;185:1268-1273.
21.
Loeb S, Kan D, Helfand BT, et al: Is statin use associated with prostate cancer aggressiveness. BJU Int 2009;105:1222-1225.
22.
Hamilton RJ, Banez LL, Aronson JWJ, et al: Statin medication use and the risk of biochemical recurrence after radical prostatectomy. Cancer 2010;116:3389-3398.
23.
Ku JH, Jeong CW, Park YH, et al: Relationship of statins to clinical presentation and biochemical outcomes after radical prostatectomy in Korean patients. Prostate Cancer Prostatic Dis 2011;14:63-68.
24.
Ritch CR, Hruby G, Badani KK, et al: Effect of statin use on biochemical outcome following radical prostatectomy. BJU Int 2011;108:211-216.
25.
McCullough AR: Prevention and management of erectile dysfunction following radical prostatectomy. Urol Clin N Am 2001;28:613-627.
26.
Morelli A, Chavalmane AK, Filippi S, et al: Atorvastatin ameliorates sildenafil-induced penile erections in experimental diabetes by inhibiting diabetes-induced RhoA/Rho-kinase signaling hyperactivation. J Sex Med 2009;6:91-106.
27.
Castroa MM, Rizzia E, Rascadob RR, et al: Atorvastatin enhances sildenafil-induced vasodilation through nitric oxide-mediated mechanisms. Eur J Pharmacol 2004;498:189-194.
28.
Hall SA, Kupelian V, Rosen RC, et al: Is hyperlipidemia or its treatment associated with erectile dysfunction? Results from the Boston Area Community Health (BACH) survey. J Sex Med 2009;6:1402-1413.
29.
Do C, Huyghe E, Lapeyre-Mestre M, et al: Statins and erectile dysfunction: results of a case/non-case study using the French Pharmacovigilance System Database. Drug Saf 2009;32:591-597.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.