Effect of statins and thiazides on PSA

[Dondodoc]

Learned users of this site. Diagnosed psa in March 2014 at 5.7 reference point at that time in UK for referral was 4.5. Was not referred as GP said in 3 weeks you will be 70 reference for that age increases to 6.5. Prescribed Finasteride for BHP, 3 years later ! Stopped the Finasteride PSA 11.2 Gleason 9 grade 4 Mets to spin/pelvis. Seeking advice on the effects of statins and thiazides on their effect causing psa to artificially reduce on testing. I had been on theses for years due to high BP. There is little apparent reporting on this in the Uk but have seen a number of reports in the USA and other countries but can’t find firm conclusions. Any help gratefully received from “our club”

Don

[Magnus1964]

Are you still on zytiga? I don't think the finasteride is doing anything for you.

[Dondodoc in reply to Magnus1964]

Hi Magnus, went on Finasteride for apparent diagnosis for BPH . When it was actually PCa. Currently still on zytiga and prednisone. Still working PSA 0.25.

Don

[pjoshea13]

Don,

The major concern with drugs that reduce PSA is that the drugs are not taken into account during screening. For example, Finasteride would lower excess PSA caused by BPH & a 4.5 'reference point' would be too high. I would not use the word "artificial" to describe the lowering.

If the prostate has been removed, the PSA is due to the cancer. If a drug reduces PSA, that is considered a good thing. Researchers use PSA all the time in clinical trial. For instance, a target end-point might be >50% PSA reduction. No one worries that the drop in PSA might be "artificial".

Some in this group want it both ways. i.e. it's OK to use PSA in trials but not when using supplements. LOL

I am on a statin (have been for a dozen years) purely because of reported PCa benfits.

There seems to be a survival issue with thiazides [1]. Perhaps you could switch to an ACE inhibitor? Note that I am not a doctor.

-Patrick

[1] pubmed.ncbi.nlm.nih.gov/240...

[Dondodoc in reply to pjoshea13]

Hi Patrick, there is a suggestion that in not being referred when psa was at 5.7 the gp was negligent. It is questionable whether that result was “artificially “ reduced following years of taking statins and thiazides and would have resulted in an even higher psa had it not been for those medications

Don

[LowT]

Finasteride will lower PSA and statins can cause some lowering of TT and fT.

[Tall_Allen]

I don't know about thiazides, but there is a danger that statins (as well as many other things that I've seen mentioned on this forum) may artificially lower PSA . Here's what I know:

pcnrv.blogspot.com/2019/04/...

Finasteride actually improves the diagnostic ability of of PSA. It is quite good at reducing the PSA coming from BPH and quite poor at reducing the PSA coming from prostate cancer. If you just have BPH, your PSA should be cut in half (approximately), and stay at that level. If it never goes down while using it (this was my experience), or if it goes down but then creeps back up, other causes are suspected.

[Dondodoc in reply to Tall_Allen]

Dear Tall_Allen thank you for your comments. You may gather that this has turned legal in respect of negligence. I made my post based upon an article I stumbled across on the internet. The American Society of Clinical Oncology, and I have no knowledge of their standings being UK bases, published a report on the effect of medications on PSA. It appears a fairly limited trial based upo some 4000 people. With a baseline of zero variation in PSA for people not on medication it showed that nsaids reduced psa by circa 5% statins by about 10% and thiazides by around 26% overs 5 year period . I was on both statins and thiazides over a similar period which may suggest that my psa was nearer 7.2 than the 5.7 in 2014. SadlyI can’t find confirmation of the report.

Don

[Currumpaw in reply to Dondodoc]

Hey Dondodoc!

Your anger is understood and justified.

Is your mission to prevent what has happened to you from being done to someone else?

Three weeks--two words--and what might have been prevented.

The "guidelines" as to how to treat disease based on age rather then the individual--is very concerning.

My best to you.

Currumpaw

[Dondodoc in reply to Currumpaw]

Hi Currumpaw, I want to prevent anyone going through misdiagnosis through ignorance. My GP was ignorant self opinionated and negligent. Sadly I am bitter, and I should perhaps apologise for that.

Cheers Don

[Currumpaw in reply to Dondodoc]

Hey Dondodoc!

I understand your bitterness.

Doctors do have their moments.

Currumpaw

[Schwah in reply to Tall_Allen]

I’ve heard that many of the supplements mentioned in your article can mask psa. But not statins. And no mention if statins in your article. What are your thoughts on statins?

Schwah

[Tall_Allen in reply to Schwah]

Look again. Just click on the two links provided.

[Schwah]

But shouldn’t men with APC be in statins anyway ? It seems to reduce BCR and mortality pubmed.ncbi.nlm.nih.gov/267...

Schwah

[Schwah]

But shouldn’t men with APC be in statins anyway ? It seems to reduce BCR and mortality pubmed.ncbi.nlm.nih.gov/267...

Schwah

[Tall_Allen in reply to Schwah]

I just noticed this - I assume you meant it for me, although you didn't reply to me. If you meant it for someone else, ignore this response.

To answer your question... Such low quality evidence as you cited is almost always wrong because of selection bias and unmeasured confounders. You can just as easily "prove" that statins make PC worse:

bjui-journals.onlinelibrary...

karger.com/Article/Abstract...

clinical-genitourinary-canc...

The best quality evidence we have to date, a Mendelian randomization study, shows there is no benefit to prostate cancer outcomes in men who have a genetic mutation that simulates what statins do:

nejm.org/doi/full/10.1056/N...

There are some good reasons to take statins (I do!), but there is no good evidence yet that there is a benefit for prostate cancer.

[Hidden]

Your GP needs to be educated with regards to PSA tests. I was sent for a biopsy at age 66, here in the states, after a DRE turned up uneven firmness. I was diagnosed Gleason 8. My PSA at the time? Only 2.7. Reliance on PSA thresholds seems silly from my perspective. BTW, did you ever endure DRE testing? I asked my GP to bump my dose of atorvastatin from 10 mg to 20 mg after reading of the benefits of statins on this forum. I had TURP surgery for BPH 10 years prior to my prostate cancer diagnosis.