Lauren M. Green
Among undiagnosed men who took regular aspirin, the risk of developing a lethal form of prostate cancer was reduced by 24 percent, and among those already diagnosed with the disease, regular aspirin use lowered their risk of dying from it by 39 percent. This research was announced in advance of the 2016 Genitourinary Cancers Symposium, a meeting put on by the American Society of Clinical Oncology (ASCO) of hundreds of oncologists and other oncology professionals in San Francisco from January 7-9, 2016.
Notably, however, regular aspirin use before diagnosis did not confer a measurable benefit for the prevention of overall, high-grade, or locally advanced prostate cancer, reported the study’s lead author, Christopher Brian Allard.
“Our study demonstrates that regular aspirin intake may inhibit lethal prostate cancer, probably by preventing cancer progression,” said Allard, the study’s lead author and a urologic oncology fellow at Brigham and Women’s Hospital and Massachusetts General Hospital. “Men with prostate cancer who took aspirin regularly after diagnosis had a significantly reduced risk of death.”
For their study, researchers followed 22,071 men who were enrolled in the Physicians’ Health Study between 1982 and 2009. Participants’ aspirin use and prostate cancer status were reviewed annually via questionnaires and review of hospital records. The primary focus of the research was whether there was a relationship between regular aspirin use (defined as more than three tablets per week) and lethal prostate cancer (defined as metastatic disease or death from prostate cancer). The study marked the first to specifically examine this relationship, its authors noted.
After 27 years of follow-up, 3,193 men developed prostate cancer, of which 403 cases were lethal. After adjusting for differences in age, race, body mass index, and smoking status, men without prostate cancer who took aspirin regularly had a 24 percent lower risk of developing the disease.
“When we looked at the subset of men who were already diagnosed with prostate cancer,” Allard continued, “we found that regular aspirin intake decreased the risk of prostate cancer death by almost 40 percent."
Optimal Aspirin Dose Unclear
The main limitation of the study, noted Allard, is the variability in dose and frequency of aspirin use over the nearly three decades of participant follow-up. When the Physicians’ Health Study was launched in 1982 as a randomized trial, participants took aspirin every other day at a dose of 325 mg, but that trial was stopped after five years when aspirin’s cardiovascular benefit was clearly established; thereafter, men were followed for another 22 years, and Allard explained that although they provided detailed reports of frequency of aspirin use, “it wasn’t always clear what dose they were taking,” though 81 mg did emerge as a popular dose.
Allard said that he and colleagues will continue to explore how aspirin may decrease the risk of prostate cancer mortality, adding that “more work is needed to identify particular subsets of men most likely to benefit from aspirin use and to determine the optimal aspirin dose.”
“It is premature to recommend aspirin use for prevention of lethal prostate cancer, but men with prostate cancer who may already benefit from aspirin’s cardiovascular effects could have one more reason to consider regular aspirin use,” said Allard, adding that men considering aspirin use should consult their physician to discuss benefits and risks.
Weighing Benefits and Risks
Presscast moderator and ASCO expert Sumanta Pal, noted that whereas “we often think of prostate cancer as being a rather slow-growing or indolent disease, it’s really important to keep in mind that over 25,000 men die of prostate cancer each year.”
“This study suggests that there may be yet one more benefit of aspirin, beyond those we’ve already seen in colorectal cancer and heart disease, Pal continued. “While taking aspirin does carry certain side effects that patients should discuss with their physician, it’s intriguing that this low-cost medicine may lower the risk of death from prostate cancer.”
Allard CB, Downer MK, Preston MA, et al. Regular aspirin intake 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.