Aspirin ... again

[pjoshea13]

New Danish study.

"Postdiagnosis use of low-dose aspirin (75 to 150 mg) was defined as 2 or more prescriptions filled within 1 year after prostate cancer diagnosis." "Data on over-the-counter aspirin use were unavailable."

"... analyses showed that prostate cancer mortality was slightly reduced with low-dose aspirin use after the 5-year (HR, 0.91...) and 7.5-year (HR, 0.84 ...) postdiagnosis exposure periods ..."

"... low-dose aspirin use might be inversely associated with prostate cancer mortality after 5 years ..."

Low-dose aspirin is sufficient to inhibit the aggregation of platelets, which precedes the build up of fibrin in clot formation. It has been suggested that inhibition of abnormal coagulation inhibits metastasis. Alteration of normal levels of coagulation factors can occur long before diagnosis. A DVT may be the first warning of undiagnosed PCa.

-Patrick

ncbi.nlm.nih.gov/pubmed/308...

Ann Intern Med. 2019 Mar 5. doi: 10.7326/M17-3085. [Epub ahead of print]

Use of Low-Dose Aspirin and Mortality After Prostate Cancer Diagnosis: A Nationwide Cohort Study.

Skriver C1, Dehlendorff C1, Borre M2, Brasso K3, Larsen SB4, Dalton SO5, Nørgaard M2, Pottegård A6, Hallas J6, Sørensen HT2, Friis S7.

Author information

1

Danish Cancer Society Research Center, Copenhagen, Denmark (C.S., C.D.).

2

Aarhus University Hospital, Aarhus, Denmark (M.B., M.N., H.T.S.).

3

Copenhagen University Hospital, Copenhagen, Denmark (K.B.).

4

Danish Cancer Society Research Center and Copenhagen University Hospital, Copenhagen, Denmark (S.B.L.).

5

Danish Cancer Society Research Center, Copenhagen, Denmark and Zealand University Hospital, Næstved, Denmark (S.O.D.).

6

University of Southern Denmark, Odense, Denmark (A.P., J.H.).

7

Danish Cancer Society Research Center and University of Copenhagen, Copenhagen, Denmark, and Aarhus University Hospital, Aarhus, Denmark (S.F.).

Abstract

BACKGROUND:

Recent studies suggest that aspirin use may improve survival in patients with prostate cancer.

OBJECTIVE:

To assess the association between postdiagnosis use of low-dose aspirin and prostate cancer mortality.

DESIGN:

Nationwide cohort study.

SETTING:

Denmark.

PATIENTS:

Men with incident prostate adenocarcinoma between 2000 and 2011.

MEASUREMENTS:

Nationwide registry data on tumor characteristics, drug use, primary prostate cancer therapy, comorbidity, and socioeconomic parameters. Postdiagnosis use of low-dose aspirin (75 to 150 mg) was defined as 2 or more prescriptions filled within 1 year after prostate cancer diagnosis. Follow-up started 1 year after prostate cancer diagnosis. In secondary analyses, low-dose aspirin use was assessed within exposure periods of 5 or 7.5 years after prostate cancer diagnosis.

RESULTS:

Of 29 136 patients (median age, 70 years), 7633 died of prostate cancer and 5575 died of other causes during a median follow-up of 4.9 years (interquartile range, 3.1 to 7.2 years), through 2015. Postdiagnosis low-dose aspirin use was associated with adjusted hazard ratios (HRs) of 0.95 (95% CI, 0.89 to 1.01) for prostate cancer-specific mortality and 1.12 (CI, 1.05 to 1.20) for other-cause mortality. The secondary analyses showed that prostate cancer mortality was slightly reduced with low-dose aspirin use after the 5-year (HR, 0.91 [CI, 0.83 to 1.01]) and 7.5-year (HR, 0.84 [CI, 0.72 to 0.97]) postdiagnosis exposure periods, notably among patients filling prescriptions for a large quantity of low-dose aspirin tablets during the 7.5-year period.

LIMITATIONS:

Data on over-the-counter aspirin use were unavailable. Some residual confounding was possible as a result of incomplete data on some prognostic factors.

CONCLUSION:

The study did not support an overall effect of postdiagnosis low-dose aspirin use on prostate cancer mortality. However, results for extended exposure periods suggest that low-dose aspirin use might be inversely associated with prostate cancer mortality after 5 years from cancer diagnosis.

PRIMARY FUNDING SOURCE:

Danish Cancer Society.

PMID: 30831581 DOI: 10.7326/M17-3085

[snoraste]

This is interesting because unlike other findings on the subject that I've seen, it looks at the conditional long term effect: patients who live longer will benefit the most.

[pjoshea13 in reply to snoraste]

The study is being reported in a negative way. The message being:- don't bother. But my take is:

- the probability of being alive 5 years after diagnosis is quite good (at a group level)

- if a man has been taking aspirin for 5 years - don't stop because of the media headlines

- if a man is concerned about the possibility of a future PCa diagnosis - start now.

An earlier study reported that the benefit was limited to men with more serious disease:

"... among men diagnosed with high-risk cancers (≥ T3 and/or Gleason score ≥ 8), postdiagnosis daily aspirin use was associated with lower {prostate cancer-specific mortality} (HR = 0.60 ...), with no clear difference by dose (low-dose, typically 81 mg per day, HR = 0.50 .., higher dose, HR = 0.73 ..."

ncbi.nlm.nih.gov/pubmed/253...

I'll take a stab at explaining the numbers. There was 50% lower mortality risk in men specifically inhibiting platelet clumping. There was only a 27% reduction in the group which included men who were using aspiirin for other reasons. Those men might have had elevated markers of inflammation. Chronic inflammation increases mortality risk.

-Patrick

[Adam10 in reply to pjoshea13]

Would you kindly comment on the studies comments for PCa sufferers with Gleeson score of 3+4.

Not aware of my T score but my NAIDs score was 4.

I have not been taking aspirin but am interested to know if it would help.

Thank you for posting your valuable insight on these studies.

[pjoshea13 in reply to Adam10]

Adam,

I see a reference to "Gleason score ≥ 8", but not lesser Gleason score 3+4 specifically. But it seems that benefit may be related to metastatic potential. (Not every case progresses towards metastasis.)

-Patrick

[curious-mind1 in reply to pjoshea13]

Wow, a seeming reduction of 16% (HR 0.84) for men using aspirin over 7.5 years sounds rather good.

Quick question for those like me who might be interested in takin low-dose preventatively (dad and grandfather both have/had advanced PCa): would 3 times a week of 81mg suffice for a low-dose regimen, or do they mean daily intake?

Arthur

PS - Incidentally, a major study out of the UK recently announced similar risk reduction effect in the transition of Barrett's esophagus into esophageal cancer. People who took low-dose aspirin for years, along with PPI acid reducers, experienced significantly less progression towards cancer. Clearly, aspirin seems to be playing a role in prevention or reduction of disease severity.

[pjoshea13 in reply to curious-mind1]

The normal dose for platelet aggregation inhibition is 81 mg daily.

Personally, I prefer to use nattokinase to deal with abnormal clotting. Admittedly, aspirin targets the initiation stage, whereas nattokinase works after the fact - i.e. fibrinogen must be converted to fibrin before nattokinase can dissolve it. A D-dimer test should be used to monitor the dose. Even if one were to rely on aspirin alone, a D-dimer test should be used to verify that there is no active clot.

I am sure that there are more than a few men here with Barrett's who would be interested in the study you mentioned:

ncbi.nlm.nih.gov/pmc/articl...

I had a bad experience with a PPI. It can "unmask" Clostridium difficile, which is no fun at all. In my case, that led to lymphocytic colitis, which took me a few years to get rid of.

-Patrick

[curious-mind1 in reply to pjoshea13]

Thanks Patrick, I think I'm definitely gonna consider starting a low-dose Aspirin regimen, even if slowly, 3-4 times a week.

Incidentally, regarding the PPIs, last year I finished a 2-month PPI regimen to get rid of erosive esophagitis, where two biopsies didn't find Barrett's (thankfully). The doctor was aware of the study, but also suggested that for people who experience reflux, but without severe erosive esophagitis, maintenance using 40mg of Pepcid daily is very likely to be safe long-term (especially with aspirin).

Arthur

[j-o-h-n]

No not again. Danish with coffee is incorrect, it's Viennese (wienerbrød) with coffee.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/06/2019 7:21 PM EST