Regular Aspirin Use and the Risk of Lethal Prostate Cancer in the Physicians' Health Study

Mary K Downer; Christopher B Allard; Mark A Preston; J Michael Gaziano; Meir J Stampfer; Lorelei A Mucci; Julie L Batista

doi:10.1016/j.eururo.2017.01.044

Regular Aspirin Use and the Risk of Lethal Prostate Cancer in the Physicians' Health Study

Eur Urol. 2017 Nov;72(5):821-827. doi: 10.1016/j.eururo.2017.01.044. Epub 2017 Feb 8.

Authors

Mary K Downer¹, Christopher B Allard², Mark A Preston³, J Michael Gaziano⁴, Meir J Stampfer⁵, Lorelei A Mucci⁶, Julie L Batista⁷

Affiliations

¹ 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. Electronic address: mkd690@mail.harvard.edu.
² Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Surgery, Joseph Brant Memorial Hospital, Burlington, ON, Canada.
³ Division of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁴ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
⁵ 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 Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: stampfer@hsph.harvard.edu.
⁶ Department of Epidemiology, 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.
⁷ 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.

PMID: 28189429
DOI: 10.1016/j.eururo.2017.01.044

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, β-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.

Keywords: Aspirin; Lethal prostate cancer; Prostate cancer mortality; Prostate cancer progression.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Adult
Aged
Aged, 80 and over
Anticarcinogenic Agents / administration & dosage*
Anticarcinogenic Agents / adverse effects
Aspirin / administration & dosage*
Aspirin / adverse effects
Boston / epidemiology
Disease Progression
Humans
Male
Middle Aged
Multivariate Analysis
Physicians*
Prognosis
Proportional Hazards Models
Prospective Studies
Prostatic Neoplasms / diagnosis
Prostatic Neoplasms / epidemiology
Prostatic Neoplasms / mortality
Prostatic Neoplasms / prevention & control*
Protective Factors
Risk Factors
Time Factors

Substances

Anticarcinogenic Agents
Aspirin