Aspirin & Lethal PCa.

[pjoshea13]

New Health Professionals Follow-up Study paper below [1].

Some of the authors have been looking at aspirin & PCa for 20 years. Are we there yet?

"Participants were aged 40-75 yr at baseline in 1986 and have been followed with biennial questionnaires. The risk analysis includes 49,409 men. The survival analysis includes 5,980 PC patients without metastatic disease at diagnosis."

"We ... examine{d} the association between current, past, or never regular aspirin use (≥2 d/wk) in relation to lethal (metastatic or fatal) PC. We also examined years of use among current users and years since stopping among past users. In the risk analysis, aspirin was updated throughout follow-up. In the survival analysis, aspirin use after diagnosis was assessed."

"Some 29% of participants used aspirin regularly at baseline, which increased to 60% by 2010."

In this U.S. population, most chronic users would presumably be using low-dose aspirin prophylactically against cardiovascular events. Recent studies will likely reverse that trend, since CVD protection seems to be confined to those who have already experienced a cardiovascular event. And aspirin has safety issues even at low doses. But given that the baseline was 33 years ago, one can't make the assumption that users mostly had cardiovascular issues (although men with PCa do have elevated CVD risk.)

"451 of the men diagnosed with nonmetastatic PC later developed lethal disease" (7.5%).

"Current postdiagnostic aspirin was associated with a {~20%} lower risk of lethal PC {&} overall mortality".

Some aspirin & warfarin studies have associated use with a lower rate of metastatic (lethal) disease. Circulating cancer cells have poor survival unless they dock on microclots. Aspirin inhibits the aggregation of platelets, which is the first stage of clot formation.

Nattokinase can speed the elimination of clots & a D-dimer blood test may indicate whether there is an active clot.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/310...

Eur Urol Oncol. 2019 Mar;2(2):126-134. doi: 10.1016/j.euo.2018.07.002. Epub 2018 Jul 31.

Aspirin Use and Lethal Prostate Cancer in the Health Professionals Follow-up Study.

Downer MK1, Allard CB2, Preston MA3, Wilson KM4, Kenfield SA5, Chan JM5, Mucci LA4, Giovannucci E6, Stampfer MJ7.

Author information

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: [e-mail].

2

Department of Surgery, Joseph Brant Memorial Hospital, Burlington, ON, Canada; Division of Urology, McMaster University, Hamilton, ON, Canada.

3

Division of Urological Surgery, Brigham and Women's Hospital, Boston, MA, USA.

4

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.

5

Department of Urology, University of California-San Francisco, San Francisco, CA, USA.

6

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.

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.

Abstract

BACKGROUND:

Aspirin use probably protects against some malignancies but its effects on lethal prostate cancer (PC) are unclear.

OBJECTIVE:

To investigate the association between regular aspirin use and lethal PC.

DESIGN, SETTING, AND PARTICIPANTS:

Participants were aged 40-75 yr at baseline in 1986 and have been followed with biennial questionnaires. The risk analysis includes 49 409 men. The survival analysis includes 5980 PC patients without metastatic disease at diagnosis.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:

We used Cox proportional hazards regression to examine the association between current, past, or never regular aspirin use (≥2 d/wk) in relation to lethal (metastatic or fatal) PC. We also examined years of use among current users and years since stopping among past users. In the risk analysis, aspirin was updated throughout follow-up. In the survival analysis, aspirin use after diagnosis was assessed.

RESULTS AND LIMITATIONS:

Some 29% of participants used aspirin regularly at baseline, which increased to 60% by 2010. In the risk analysis, 804 men were diagnosed with lethal PC. Current regular aspirin was associated with a lower risk of lethal prostate cancer (hazard ratio [HR] 0.80, 95% confidence interval [CI] 0.66-0.96) compared to never users. In the survival analysis, 451 of the men diagnosed with nonmetastatic PC later developed lethal disease. Current postdiagnostic aspirin was associated with a lower risk of lethal PC (HR 0.80, 95% CI 0.64-1.00) and overall mortality (HR 0.79, 95% CI 0.69-0.90). When restricted to highly screened men, the risk analysis associations were stronger and survival analysis associations remained statistically significant. Reverse causation and residual confounding remain concerns, as demonstrated by the attenuated results in sensitivity analyses.

CONCLUSIONS:

Regular aspirin use was associated with a lower risk of lethal PC. Postdiagnostic use was associated with better survival after diagnosis.

PATIENT SUMMARY:

We found that it may be advisable for prostate cancer patients to take aspirin to improve their survival for both prostate cancer mortality and other mortality outcomes.

Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

KEYWORDS:

Aspirin; Lethal prostate cancer; Prostate cancer survival

PMID: 31017087 DOI: 10.1016/j.euo.2018.07.002

[Ralph1966]

Hi Patrick,

I am currently taking low dose of aspirin 81 mg, is this the dosage mentioned in the study? Will it be more beneficial to take the full dosage of aspirit 325mg?

[pjoshea13 in reply to Ralph1966]

Ralph,

My understanding is that 81 mg is sufficient to inhibit platelet clumping.

For the distribution of doses found in the study, one would have to see the full text, but with 60% of men using aspirin by 2010 (up from 29%), I imagine that most doses were low.

-Patrick

[Magnus1964]

I have been taking Zyflamend instead. It is an analgesic and does not hurt the stomach. Years ago there was a trial in Zyflamend and it proved effective in slowing the progression of cancer.