San Francisco, CA—Regular use of aspirin appeared to reduce the risk for dying from lethal prostate cancer in a large observational study reported at the 2016 Genitourinary Cancers Symposium.1 This evidence suggests yet another reason to take aspirin in addition to cardiovascular protection. Aspirin is cheap and widely available.
But that does not mean men with a diagnosis of prostate cancer should add aspirin to their list of medications. First, they should have a discussion with their oncologist about the risks (mainly gastrointestinal bleeding) versus benefits.
“It is premature to recommend aspirin for prevention of lethal prostate cancer, but men with prostate cancer who already may benefit from aspirin’s cardiovascular effects could have one more reason to consider regular aspirin use,” said lead author Christopher Brian Allard, MD, Urologic Oncology Fellow at Brigham and Women’s Hospital and Massachusetts General Hospital, Boston.2 “Physicians can discuss these findings with patients,” he added. Randomized controlled trials are needed to study the protective effects of aspirin in men with prostate cancer.
Dr Allard pointed out that this observational study, the Physicians’ Health Study, is the first study to focus on the role of aspirin in preventing advanced disease and prostate cancer–related death.
The study enrolled 22,071 male physicians. After 27 years of follow-up, 3193 men were diagnosed with prostate cancer and 403 of them developed lethal prostate cancer. For purposes of this study, lethal prostate cancer was defined as metastatic disease or prostate cancer–specific death.
Regular aspirin use (3 or more tablets per week) reduced the risk for developing lethal cancer by 24% in men without a diagnosis of prostate cancer in the overall trial compared with nonusers, according to a multivariate analysis adjusted for age, race, body mass index, and smoking status. Among men with a diagnosis of prostate cancer, regular aspirin use after diagnosis reduced the risk of prostate cancer–specific death by 39% compared with nonusers.
Dr Allard emphasized that regular aspirin use had no effect on the development of prostate cancer, high-grade prostate cancer, or locally advanced disease.
At a premeeting presscast, Dr Allard said that he and his co-investigators plan to study mechanisms related to aspirin’s effect on lethal prostate cancer and to determine which subsets of men might benefit. Also, the study did not control for dose of aspirin, so optimal dose remains to be determined.
“This is a provocative paper, but it is an observational study, and we need formal clinical trials to determine the right dose, and the right patients who will benefit. Remember, aspirin causes bleeding,” said presscast moderator Sumanta Pal, MD, ASCO spokesperson. Dr Pal is with City of Hope, Duarte, CA, and was not involved in this study.
1. Allard CB, Downer MK, Preston MA, et al. Regular aspirin use and the risk of lethal prostate cancer in the Physicians’ Health Study. Presented at: 2016 Genitourinary Cancers Symposium; January 7-9, 2016; San Francisco, CA. Abstract 306.
2. Regular aspirin use may reduce risk of dying from prostate cancer [press release]. Alexandria, VA: American Society of Clinical Oncology; January 4, 2016. www.asco.org/press-center/regular-aspirin-use-may-reduce-risk-dying-prostate-cancer. Accessed January 13, 2016.