Anti-PCa effects of statins, prednisone, aspirin and denosumab (Xgeva)

[Derf4223]

A while ago I posted about the high importance of getting a bone density scan.

People here spend a lot of time worrying about deleterious potential side effects, even from commonly prescribed statins and prednisone. But as far as I can tell also have anti-PCa effects.

When my recent bone density scan came back osteopenic, my MO immediately recommended denosumab which is yet another medicine with an SE or 2-3. After studying its effects, I can see why.

I will be getting it in late December, and already get prednisone in conjunction with abiraterone, and am on a statin I used to need but no longer for lipid purposes.

Does anyone have info about low dose aspirin with regard to anti-PCa effects? From my readings it does and as of now I'm adding it.

Control what you can control.

[Tall_Allen]

Our highest level evidence (Level 1) shows that aspirin does not delay progression:

thelancet.com/journals/lanc...

And may contribute to cancer death:

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

Xgeva is usually reserved for castration resistance or full osteoporosis because serious side effects accumulate over time. We have evidence that Zometa+Celebrex (but not either alone) increases survival.

[Derf4223 in reply to Tall_Allen]

The first article you cited says the higher mortality data was suspicious. It drew participants who were "relatively healthy" from "community settings." My gut says that people from community settings are probably not that healthy to start with and probably not exercising 10-15 hours per week.

The second article is about a Chinese trial using 53 participants. IMO useless. Its alleged purposes were to see what effect aspirin had on benign-to-metastatic and hormone sensitive to castration resistance. Not mortality.

Now consider these if you like.

journals.lww.com/oncology-t...

pubmed.ncbi.nlm.nih.gov/245... suggests that the incidence of higher PCa lethality is "nonsignificant." And that it does help avoid colon cancer. (Lest we folks with PCa forget other illnesses lurk. And in my case, due to RT I am not a candidate for colonoscopies and for colon cancer am relying on FIT sample testing, so if aspirin reduces it I am 100%-on-board.)

And this one suggests that it helps if one has low aggression PCa uspharmacist.com/article/wh...

And this one says that aspirin dose size matters -- high doses associated with higher cancer lethality, low doses help a slew of cancer types. frontiersin.org/articles/10...

And this one says that extended use (5 years+) is associated with lower PCa lethality. (Duh -- if you last 5 years aren't the odds good you'll be around for a couple more?!) cancernetwork.com/view/stud...

This article is long but worth scanning through. Bottom line aspirin use _may_ help with advanced PCa mortality. aacrjournals.org/cebp/artic...

Cheers

[Tall_Allen in reply to Derf4223]

The ASPREE trial recruited over 19,000 people from throughout the US and Australia. "Community" is a strength of the study - it means they did not discriminate by persons who had the wherewithal to come to a large tertiary care facility - it reflects the average person.

The Chinese trial found "Our data do not show that aspirin or levofloxacin help to decrease the incidence of prostate cancer occurrence, delay castration-resistant prostate cancer transformation, or reduce tumour-associated death." It is small, but at least is a randomized trial, and not just a retrospective cohort or case-control study.

What is confusing you, as it does many patients, is that not all evidence has the same importance. Scientists have closely studied the types of evidence and categorized them according to whether it is likely to be true and replicable or not. If you are going to search for evidence, it is the first thing (and how to GRADE evidence) you should learn. Higher levels of evidence supersede lower levels of evidence ( which is what you rely on). The ASPREE trial is high GRADE Level 1 evidence of supersedes all previous studies.