New study below [1].
I believe that in the U.S. more than half of men my age are using a statin. On the other hand, I sense antipathy towards statins among many who are not using them. Certainly, there are sites such as Mercola's that contain dire warnings.
In my case, I had no interest in lowering cholesterol, but the PCa literature suggested a benefit, so I asked my doctor for high-dose Simvastatin. He wouldn't give me Metformin, but anyone who asked could get a statin.
The new paper opens with:
"Statins may potentiate the effects of anti-hormonal agents for metastatic castration-resistant prostate cancer (mCRPC) through further disruption of essential steroidogenic processes."
A statin will reduce the availability of cholesterol to PCa cells, & prevent the cells from manufacturing it. This limits the potential for cancer cells to make androgens from cholesterol.
"Five hundred and ninety-eight patients treated with second-line abiraterone or enzalutamide after docetaxel for mCRPC were included. A total of 199 men (33.3%) received statins during abiraterone/enzalutamide treatment. Median OS was 20.8 months ... for patients who received statins, versus 12.9 months ... for patients who did not receive statins".
"After adjusting for age, alkaline phosphatase, PSA, neutrophil-to-lymphocytes ratio, Charlson comorbidity score, Gleason score, visceral disease, hemoglobin, opiate use and abiraterone versus enzalutamide treatment, the use of statin therapy was associated with a 53% reduction in the overall risk of death".
"Statin use was also associated with a 63% increased odds of a > 30% PSA decline within the first 12 weeks of treatment".
There is a case for beginning statin use at the start of ADT, or even at diagnosis, IMO. Potential benefit should increase as the screws are tightened, so it's no surprise to see the results after after Zytiga or Xtandi were added, even at such a late stage.
What was not mentioned in the Abstract is if statins increased the mean-time-to-failure of the other drugs.
-Patrick
[1] ncbi.nlm.nih.gov/pubmed/297...
Oncotarget. 2018 Apr 13;9(28):19861-19873. doi: 10.18632/oncotarget.24888. eCollection 2018 Apr 13.
Statin use and survival in patients with metastatic castration-resistant prostate cancer treated with abiraterone or enzalutamide after docetaxel failure: the international retrospective observational STABEN study.
Gordon JA#1, Buonerba C#2,3, Pond G4, Crona D5, Gillessen S6, Lucarelli G7, Rossetti S8, Dorff T9, Artale S10, Locke JA1, Bosso D2, Milowsky MI5, Witek MS6, Battaglia M7, Pignata S11, Cherhroudi C12, Cox ME1, De Placido P2, Ribera D2, Omlin A6, Buonocore G13, Chi K14, Kollmannsberger C14, Khalaf D14, Facchini G8, Sonpavde G15, De Placido S2, Eigl BJ14, Di Lorenzo G2.
Author information
1
Vancouver Prostate Center, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
2
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
3
Istituto Zooprofilattico Sperimentale del Mezzogiorno, Portici, Italy.
4
McMaster University, Hamilton, Ontario, Canada.
5
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.
6
Department of Medical Oncology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
7
Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy.
8
S.S.D Oncologia Clinica Sperimentale Uro-Andrologica, Dipartimento Corp-S Assistenziale dei Percorsi Oncologici Uro-Genitale, Istituto Nazionale Tumori Fondazione G. Pascale-IRCCS, Naples, Italy.
9
University of Southern California Keck School of Medicine, Norris Comprehensive Cancer Center, Los Angeles, California, USA.
10
Oncology Department, Ospedale di Gallarate ASST Valle Olona, Gallarate, Italy.
11
Division of Medical Oncology, Department of Uro-Gynecologi cal Oncology, Istituto Nazionale Tumori Fondazione G. Pascale-IRCCS, Naples, Italy.
12
Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
13
Hospital Directorate, Azienda Ospedaliera Universitaria Federico II of Naples, Naples, Italy.
14
BC Cancer, Vancouver, British Columbia, Canada.
15
Genitourinary Oncology Section, Dana Farber Cancer Institute, Boston, Massachusetts, USA.
#
Contributed equally
Abstract
BACKGROUND:
Statins may potentiate the effects of anti-hormonal agents for metastatic castration-resistant prostate cancer (mCRPC) through further disruption of essential steroidogenic processes. We investigated the effects of statin use on clinical outcomes in patients with mCRPC receiving abiraterone or enzalutamide.
MATERIALS AND METHODS:
This was a retrospective multicenter study including patients that received abiraterone or enzalutamide for mCRPC. The effect of concurrent statin use on outcomes was evaluated. The associations of statins with early (≤12 weeks) prostate-specific antigen (PSA) declines (> 30%), cancer-specific survival and overall survival (OS) were evaluated after controlling for known prognostic factors.
RESULTS:
Five hundred and ninety-eight patients treated with second-line abiraterone or enzalutamide after docetaxel for mCRPC were included. A total of 199 men (33.3%) received statins during abiraterone/enzalutamide treatment. Median OS was 20.8 months (95% CI = 18.3-23.2) for patients who received statins, versus 12.9 months (95% CI = 11.4-14.6) for patients who did not receive statins (P < 0.001). After adjusting for age, alkaline phosphatase, PSA, neutrophil-to-lymphocytes ratio, Charlson comorbidity score, Gleason score, visceral disease, hemoglobin, opiate use and abiraterone versus enzalutamide treatment, the use of statin therapy was associated with a 53% reduction in the overall risk of death (hazard ratio [HR] = 0.47; 95% CI = 0.35-0.63; P < 0.001). Statin use was also associated with a 63% increased odds of a > 30% PSA decline within the first 12 weeks of treatment (OR = 1.63; 95% CI = 1.03-2.60; P = 0.039).
CONCLUSIONS:
In this retrospective cohort, statin use was significantly associated with both prolonged OS and cancer-specific survival and increased early > 30% PSA declines. Prospective validation is warranted.
KEYWORDS:
abiraterone; enzalutamide; prostate cancer; statins
PMID: 29731989 PMCID: PMC5929432 DOI: 10.18632/oncotarget.24888
Pembrolizumab in Patients With Heavily Treated Metastatic Castration-Resistant Prostate Cancer 
