Statin Dosage

[DFL208]

I have been taking 20mg of atorvastatin for a number of years. In a conversation with my Family Practicioner who prescribes my atorvastatin, I mentioned a recent study that suggests a positive effect of statins on advanced prostate cancer mortality. If I read the study correctly, most of the patients were using high potency statins. She offered to increase my atorvastatin dosage from 20 mg to 40 mg. My cholesterol, HDL and triglycerides are managed well at 20 mg. The increased dosage would relate to my advanced prostate cancer. I would appreciate thoughts on whether i should take her up on the offer to go from 20 mg to 40mg atorvastatin. Thanks.

[Tall_Allen]

Whatever "study" you're referring to doesn't show what you think it shows. There are a lot of "studies" that people post on this site that should never be used for treatment decisions. The best study we have so far shows there is no effect for prostate cancer. It is the "best" study because it at least simulates a randomized clinical trial. Here it is:

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

The kinds of studies that are misleading you are called "observational studies." They are almost always wrong. Here's a couple of observational studies that "show" that statins make things worse:

bjui-journals.onlinelibrary...

karger.com/Article/Abstract...

There is a big problem with all observational studies that medical researchers usually are aware of, but google-researchers on this site usually are not - the patients who take the drug are different from patients who don't (e.g., more attentive to their health, see doctors more often, etc.). This is called "selection bias." There is also the problem of "unmeasured confounders," if for example, men with heart disease take beta-blockers too, and it is the beta-blocker that has the real effect..

I suspect statins interfere with PSA tests:

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

If you were taking a low dose statin for its cardiovascular effects, that might be a good reason to take it. But as you raise your statin dose, you increase the possibility of myopathy - it happened to me when my GP increased my atorvastatin dose from 20 mg to 40 mg. I went back to 20 mg and the muscle pain went away.

[LearnAll in reply to Tall_Allen]

That is correct. Exactly same thing happened to me. My doctor increased atorvastatin dose to 20 mg a day from 10 mg a day and I started having calf muscle pains. Reduced back to 10 mg a day and its gone. LDL 87, total Chole 186. HDL 61 Just with 10 mg Atorvastatin a day. But I also eat Garlic and Onions daily in food and that might be helping too.

[Engraver68]

Hi

I also take statins and have for the past 20 years after a blockage was stented successfully.

I had always had a low cholesterol level but the heart disease is hereditary. I started on 20mg then after a number of years my Cardiologist increased dosage to 40mg daily then 80mg and I questioned this.

Reply was there is evidence that the body once able to cope with statins and no side effects is just as well treated with a higher dosage to avoid any cholesterol build up over time, that was before I had Prostate cancer diagnosis and treatment 10 years ago and I continue to be treated with Abiraterone + Predniselone + Lupron shot.

I guess its what they call 'Following the Science' hear in the UK!

I'd go for it as it seems to have an added benefit with POC treatments.

[EdBar]

It depends what your current lipid panel looks like. When I was initially dx I increased my statin (Crestor) in order to reduce my LDL level per Snuffy Myers. After switching to a Mediterranean diet - per Snuffy my LDL/cholesterol levels became too low and I reduced my stain level to a much lower dose - per Snuffy. Your body needs a certain level of cholesterol to function properly especially brain function which usually takes a hit from long term ADT.

Ed

[Frigataflyer]

40 mg Atorvastatin/day is the dosage recommended by Care Oncology.

[Ran2599dy]

Be careful with the dosage. Snuffy had me on Crestor 20mg and my cholesterol came back at below 100. Had problems walking and he reduced me to 5mg. He also stated, try to keep cholesterol around 120

[dadzone43]

no harm unless you get muscle damage from the higher dose

[Hidden]

I got my GP to increase my atorvastatin dose from 10 mg to 20 mg. No problems with muscles. My PSA stabilized at 0.5 after that change. Coincidence? Maybe. My PSA had been slowly increasing.

[cam123]

I think this could be the study being referenced. Some promising findings and the data perhaps suggest hypotheses for further studies.

"Statins May Lower Mortality in High-Risk Prostate Cancer Patients

Statin use alone or with metformin is associated with lower prostate cancer mortality from all causes, among high-risk patients.

Family man

PHILADELPHIA – Among high-risk prostate cancer patients – those with high PSA and Gleason scores of 8 or more – many will develop a difficult-to-treat disease. Preliminary research suggests that two commonly prescribed medications, cholesterol-lowering statins and the diabetes therapy metformin may have anticancer effects. However, it is unclear which of these two medications – commonly prescribed together -- contributes the most and whether they can impact high-risk prostate cancer. New research shows that statins, alone or with metformin, increase survival in men with high-risk prostate cancer.

“Both metformin and statins have been associated with longer life in prostate cancer patients, yet because they are commonly prescribed together, no study we know of has looked at these two medications separately,” says senior author Grace Lu-Yao, PhD, associate director of Population Science at the Sidney Kimmel Cancer Center—Jefferson Health, one of only eight NCI-designated cancer centers nationwide with a prostate cancer program of excellence.

The study, published in Cancer Medicine on Feb 8th, looked at a number of statin therapies, and metformin, an anti-diabetic medication, in high-risk prostate cancer populations.

Using data from the Surveillance, Epidemiology and End Results (SEER-18) database linked with Medicare files, Dr. Lu-Yao and colleagues looked at patients diagnosed with cancer from 2007 through to 2011. Based on 12,700 patients, the researchers observed that statins alone or in combination with metformin was significantly associated with reduced mortality from all causes.

Dr. Lu-Yao and colleagues saw the highest median survival of 3.9 months in men who took both metformin and statins, 3.6 with statins alone and 3.1 years with metformin alone. The median survival for those who did not use either drug was also 3.1 years.

“With respect to prostate mortality, metformin plus statin was associated with a 36% reduction in risk of death followed by statins alone,” says Dr. Lu-Yao. “Those taking metformin alone were relatively rare, and there was no significant association with all-cause mortality.”

Interestingly, the study revealed that men who took atorvastatin, pravastatin, or rosuvastatin – but not lovastatin – demonstrated a reduction in mortality compared with non-users, which is consistent with the findings from a recent population-based cohort study using Taiwan National Health Insurance Research Data. The Taiwanese research showed that these three statins are more effective at lowering triglycerides and low-density lipoprotein cholesterol and raising high-density lipoprotein cholesterol than other statins in patients with hypercholesterolemia.

Of the three statins studied, men on atorvastatin did have a longer median time to progression on androgen deprivation therapy compared to those who weren’t treated with statins. “Although the exact mechanisms remain unknown, it is worth noting that atorvastatin exhibits a potent lipid-lowering effect per dose of any statin, and has the greatest bioavailability and one of the longest half-lives,” says to Dr. Lu-Yao.

The data presented in the current study provide crucial insight for the design of future randomized clinical trials of statin for high-risk patients with prostate cancer. Based on the existing evidence, a well-designed clinical trial is warranted to investigate the roles of statins and combination statins/metformin to reduce the mortality cancer of the prostate.

“Our study showed that the effects were more pronounced in patients taking statins after the diagnosis of prostate cancer, 54% reduction in PCA mortality among patients with high-risk prostate cancer,” says Lu-Yao. “This magnitude of reduction is comparable to the results of men treated with androgen signaling inhibitors.” Statins are relatively inexpensive with good safety records. Further studies to understand the mechanisms of the observed association and its potential clinical utility are warranted.

This work was supported by a grant from the National Cancer Institute at the National Institutes of Health (K07CA190541), the Biometrics Shared Resource of the Rutgers Cancer Institute of New Jersey (P30CA072720), and by the Sidney Kimmel Cancer Center Support Grant (5P30CA056036-18)."