Preventing Prostate Cancer


For Men, keeping cholesterol low protects against prostate cancer and erectile dysfunction

Statins, drugs widely prescribed to lower cholesterol, may have protective effects on prostate health and on male erectile function. A large Mayo Clinic study co-sponsored by Merck and Kaiser Permanente looked at possible effects of statins on three different aspects of urological health – prostate cancer, erectile dysfunction and prostate enlargement.

The Mayo Clinic study findings came from data in the Olmsted County Study of Urinary Health Status among Men, a large cohort study of men living in Olmsted County, Minn. This study has followed 2,447 men ages 40 to 79 from 1990 to the present to assess various urologic outcomes among aging men. Preliminary results of analysis of data from the study concerning statins are being presented April 25–30, 2009, at the American Urological Association (AUA) meeting in Chicago.

“One of the major advantages of this large cohort study is that the men have participated in this study for over 15 years. Because of this, we have the ability to look at associations between statin use, how long statins were used and multiple aspects of urologic function,” says Jennifer St. Sauver, Ph.D., Mayo Clinic epidemiologist and study author.

Three significant findings:

1: Statins May Reduce Risk of Prostate Cancer

Researchers followed the 2,447 men for over 15 years and discovered that men taking statins were less likely to develop prostate cancer, compared to men who did not take statins.

Of the statin users, 38 (6 per cent) were diagnosed with prostate cancer. Comparatively, non-statin users were three times more likely to develop prostate cancer, suggesting statin use may prevent development of prostate cancer.

“In recent years, it has been suggested that statin medications may prevent development of cancer. However, until now, there has been limited evidence to support this theory,” says Rodney Breau, M.D., a Mayo Clinic urologic oncology fellow who led the study. “Our research provides evidence that statin use is associated with a threefold reduced risk of being diagnosed with prostate cancer.”

Statin medications are currently used to lower cholesterol or to help prevent heart attack and stroke in high-risk patients. In the laboratory setting, researchers have observed that statin medications prevent cancer cells from dividing and, in fact, may cause some cancer cells to die.

“In the United States, one in six men will develop prostate cancer; however, far more will develop heart disease,” says Jeffrey Karnes, M.D., Mayo Clinic urologist and senior author on this study. “I tell my patients to take care of their heart -- because what’s good for the heart is also good for the prostate.”

The investigators emphasize that these results are preliminary. To determine if statins are protective for prostate cancer, randomized controlled trials are necessary, says Dr. Karnes.

2: Statin Use May Protect Against Erectile Dysfunction in Older Men

Hyperlipidemia (high lipids -- fats -- in the bloodstream), high cholesterol and other risk factors for heart disease have been shown to put men at risk for erectile dysfunction (ED). With this in mind, Mayo Clinic researchers studied 1,480 men from the Olmsted County cohort to see if men who used statins were less likely to develop erectile dysfunction, compared to men who did not use statins.

Overall, statin use was not significantly associated with a decreased risk of developing ED. However, statins were associated with a decreased risk of ED among older men (older than 60 years). Men in this age category who used statins were less likely to develop ED, compared to older men who did not use statins.

Additionally, men who took statins for a longer time were more protected against developing ED. For example, men who took statins for more than 8 or 9 years were 64% less likely to develop ED, while men who took statins for less than 3 years had about the same risk of developing ED compared to men who did not take statins.

“Protection of vascular health remains an important concomitant of preserving erectile health, says Ajay Nehra, M.D., Mayo Clinic urologist and senior study author."Our data suggest that longer use of statins may result in the lowest risk of erectile dysfunction."

ED is common, and prevalence increases with age. It affects 5 to 10 percent of men at age 40. By age 70, the condition affects 40 to 60 percent, or about 1 out of every 2 or 3 men.

3: Statin Use May Prevent Prostate Enlargement

Benign prostatic enlargement (BPH) affects 1 in 4 men ages 40 to 50 and almost half of 70- to 80-year-old men. The condition is most often diagnosed when men visit their doctors due to urinary problems prompted by prostate enlargement. Mayo Clinic researchers have found that taking statins may prevent or delay benign prostatic enlargement.

Of the 2,447 men studied, 729 (30 percent) were statin users; researchers found that statin users were 63 percent less likely to develop lower urinary tract problems and 57 percent less likely to develop an enlarged prostate.

“Statins have been shown to have anti-inflammatory effects, and previous research suggests inflammation may be associated with benign prostate disease,” says Dr. St. Sauver. “This study suggests that men’s urinary health could be improved by taking statin medications.”

Lowering Cholesterol Without Statins

Dr. Stephen Kopecky, a Mayo Clinic cardiologist, describes ways to lower LDL, or "bad" cholesterol, without taking a statin. His chat focuses on lowering cholesterol for heart health. His dietary suggestions may not all be suitable for preventing prostate cancer (e.g. on getting plant sterols from special margarine). Video runs 6 minutes.

Further Study Needed

The researchers note that further studies, particularly clinical trials, are necessary to determine whether taking statins might prevent development of this common condition.

“If you are taking a statin for a heart condition or to lower cholesterol, these studies suggest that statins could have other benefits,” says Dr. St. Sauver. “However, it’s very clear we need more information before men are advised to start taking statins for their urological health.”

Other Mayo Clinic researchers involved in this cohort study include: Michael Lieber, M.D.; Paul Crispen, M.D.; Debra Jacobson; Michaela McGree; and Naomi Gades, D.V.M. Cindy Girman, Sc.D., (Merck Research Laboratories) and Steven Jacobsen, M.D., Ph.D. (Kaiser Permanente South) also co-authored these studies.

Statin side effects: Weigh the benefits and risks

Statin side effects can be very uncomfortable, making it seem like the risks outweigh the benefits of these powerful cholesterol-lowering medications. Consider the risks and benefits.
by Mayo Clinic staff

A Note on a Sponsor

Merck, one of the co-sponsors of these studies, used to hold the patent on the statin drug Zocor (simvastin). In 2005, The UK became the first nation to provide nonprescription statins, when its National Health Service approved Merck's application to sell 10 mg simvastatin over the counter. By contrast, in January2005 FDA rejected Merck's request to make 20 mg lovastatin available OTC in the US because of concerns over safety (not efficacy). When Merck's patent on Zocor ran out in 2006, FDA approved three versions under the old generic name simvastatin. In 2007 Merck applied for a third time for FDA approval for over-the-counter sale of Mevacor (lovastatin). An FDA advisory panel voted against approving the drug for over-the-counter use on December 14, 2007.

MSNBC (Associated Press) Cholesterol drugs won't be sold over the counter - FDA panel rejects bid for nonprescription statin sales for the third time Dec 13 2007

Some physicians who treat heart disease are in favor of over the counter statins. See, for example, this 2006 article in Circulation (published by American Heart Association):Controversies in Cardiovascular Medicine Is it appropriate to make statins available over the counter? Over-The-Counter Statins Are Worth Considering in Primary Prevention of Cardiovascular Disease Antonio M. Gotto, Jr, MD, DPhil., Weill Medical College, Cornell University, New York, NY.

Edited by J. Strax.

Preventing Prostate Cancer