Is statin "out of the circle" again?

*Only for medical professionals to read for reference, Professor Zhu Yao will show you the latest articles of JAMA Oncol
.

Recently, JAMA Oncology, one of the top tumor journals, published a study on the topic "Outcomes of Screening for Prostate Cancer Among Men Who Use Statins", "Medical Oncology Channel" Professor Zhu Yao from the Cancer Hospital of Fudan University was specially invited to share this research and interpret the research results from a clinical and practical perspective, which is a "down-to-earth" clinical dry goods for the majority of doctors and patients online
.

Screening is considered to be beneficial to the early detection of cancer and the reduction of mortality.
However, systematic screening of prostate cancer can only moderately reduce the mortality of prostate cancer, but it has led to the overdiagnosis of low-risk tumors
.

At present, it is considered clinically in Europe that the harm of prostate cancer system screening based on prostate specific antigen (PSA) outweighs the benefits, leading to unnecessary diagnosis of cancers of no clinical significance
.

Statins may reduce PSA levels by reducing inflammation in the prostate or inhibiting androgen signaling.
A number of studies have observed a decrease in PSA levels in statin users.
This leads to questions about whether statins can reduce PSA-based prostate cancer screening is over-diagnosed
.
”
But at the same time, whether statins lowering PSA levels may cause prostate cancer to be diagnosed at a more advanced stage, thereby missing the best opportunity for intervention is still unknown
.

In this context, the study published by JAMA Oncology investigated the relevance of PSA-based screening on the incidence and mortality of prostate cancer in statin users and non-users
.

Medical circle: Could you please briefly introduce the findings of this research? Professor Zhu Yao: The reason why statins are considered to be related to prostate cancer is because the source of androgens is cholesterol, and statins have a strong regulatory effect on cholesterol.
Therefore, clinicians may produce statins that may affect it.
Conjecture about the occurrence and development of prostate cancer, and then carried out related research
.

This study published by JAMA Oncology confirms that PSA screening for patients taking statins can bring normal benefits (detection of high-risk prostate cancer), and does not significantly increase the detection of low-risk prostate cancer, thus reducing low-risk prostate cancer.
Risk of over-detection of prostate cancer
.

In addition, studies have suggested that the use of statins can reduce the recurrence rate of prostate cancer
.

I think the principle behind this may not be through affecting PSA levels, but through potential androgen suppression or alleviation of inflammation
.

It is worth noting that these studies are related studies, and the true connection between statins and prostate cancer needs to be confirmed by prospective clinical trials
.

Medical profession: What other factors may affect the accuracy of PSA testing or the level of PSA? Professor Zhu Yao: Actually, "affecting the accuracy of PSA testing" and "affecting the level of PSA" are two different issues
.

PSA is a specific antigen secreted by the prostate, and the accuracy of PSA detection is not only affected by prostate-related factors, but also by other basic characteristics of men
.

Factors that affect the accuracy of PSA testing include: Obesity: Some previous studies have suggested that obesity will affect the accuracy of PSA testing, which means that the same level of PSA will be "diluted" in obese men, resulting in the PSA level displayed by the PSA test.
Lower than actual
.

Drinking and sexual behavior: Drinking or having sex the day before the PSA test will congest the prostate and cause excessive secretion of PSA, which will affect the accuracy of the PSA test
.

And statins may affect PSA levels on PSA, and it is a subtle effect
.

In addition to lowering lipids, statins also have a certain effect on alleviating inflammation
.

Both this study and previous related studies believe that statins may reduce PSA levels by alleviating prostate inflammation, that is, drugs with anti-inflammatory effects may reduce PSA levels, but this conclusion needs more research to confirm
.

In addition, finasteride drugs can affect the secretion of PSA in men and reduce PSA levels from the source
.

The medical profession: Why do some prostate cancer patients who also suffer from chronic disease have a better prognosis than ordinary patients? Based on the conclusions of this study, how should cancer patients undergo chronic disease treatment? Professor Zhu Yao: This is a very interesting phenomenon in medicine, called "reactive situation"
.

Compared with other cancer patients, many patients with chronic diseases may have counter-intuitive conditions in terms of tumor survival or incidence (better than patients with non-chronic disease tumors).
There are several reasons behind this
.

First, patients with chronic diseases will undergo physical examinations and tumor screenings more frequently, so it is very likely that the tumors will be detected at an earlier stage or at an earlier stage of recurrence.
This is an advantage brought by regular inspections
.

Second, chronic diseases are often related to obesity, and many clinical studies have found that the malignancy of prostate cancer in obese patients with prostate cancer is often lower than that of other pathogenic factors related to prostate cancer (such as genetically related prostate cancer, etc.
), and its occurrence and progression Also slower
.

"In terms of specific clinical practice, we recommend that elderly patients with chronic diseases who are already using statins or other blood pressure and blood sugar control drugs continue to take them normally; but for patients with non-chronic diseases, I personally think that these drugs are deliberately used to reduce The basis of tumor recurrence rate and incidence rate is not sufficient
.

" Professor Zhu Yao said
.

Medical circle: What significance and enlightenment does this research have for the diagnosis and treatment of prostate cancer? Professor Zhu Yao: First of all, for a large population of people taking statins, the probability of overdiagnosis caused by PSA-based screening is relatively low.
This study confirms the safety of PSA testing for people taking statins
.

Second, the study opens a window for prospective studies on whether the use of statins or other drugs may have a better preventive effect on prostate cancer
.

In future larger-scale prospective studies, it is possible to explore whether other drugs such as statins and finasteride can reduce the incidence and recurrence rate of prostate cancer, so that clinicians and patients can confirm the relationship between the two.
And be more assured to implement to the application level
.

Experts comment on the essence.
The study confirms that patients taking statins can normally benefit from PSA screening (high-risk prostate cancer is detected), while reducing the over-detection of low-risk prostate cancer
.

Statins and other drugs that can relieve inflammation may indirectly improve tumor incidence and recurrence rate by alleviating inflammation, but this conclusion still needs to be confirmed by prospective studies
.

For patients with non-chronic diseases, the basis for deliberately using statins to reduce overdiagnosis, tumor incidence and recurrence rate is not sufficient
.

 Expert profile Prof.
Yao Zhu, Chief Physician, Fudan University Cancer Hospital, Doctoral Supervisor, Deputy Director of Urology, Fudan University Cancer Hospital, Secretary General, Prostate Cancer Expert Committee, Chinese Society of Clinical Oncology, Deputy Director, Shanghai Anti-Cancer Association Youth Council, Fudan, 2019 University Youth May 4th Medal Winners of the Shanghai Municipal Health Commission’s Young May 4th Medal were selected for the 2018 Shanghai “Medical Rising Stars” Outstanding Young Medical Talents were selected for the 7th Fudan University Top Ten Medical Young People were selected for the third batch of Fudan University’s Talent Program Selected as the editorial board member of Prostate Cancer and Prostatic Disease in the 2015 Shanghai Youth Science and Technology Venus Program.
The National Natural Science Review Expert won the first prize of Shanghai Science and Technology Progress Award as the second complete person.
Representative papers were published in European Urology and Clinical Cancer Research.
Magazine references: [1]Vettenranta A,et al.
Outcomes of Screening for Prostate Cancer Among Men Who Use Statins.
JAMA Oncol.
2021 Nov 24.
doi:10.
1001/jamaoncol.
2021.
5672.
https://jamanetwork.
com/journals/ jamaoncology/article-abstract/2786538 Source: Medical Oncology Channel Editor: Tian Dongliang Proofreader: Zang Hengjia Plate-making: Xue Jiao's past wonderful review of the three-year-old girl's right face with a fist-big tumor on the right face was elected Honorary Fellow of the American Academy of Surgeons, he is from Mainland China In order to establish the first rare disease area in China, the fifth person went from Shanghai to Hangzhou.
* The medical community strives to be accurate and reliable when the content of the published content is approved.
) Makes any promises and guarantees for the accuracy and completeness, and does not assume any responsibility for the outdated content and the possible inaccuracy or incompleteness of the cited information
.

Relevant parties are requested to check separately when adopting or using this as a basis for decision-making
.