SERUM LIPID PROFILE AT TIME OF ANDROGEN DEPRIVATION THERAPY AND RISK OF CASTRATION-RESISTANT PROSTATE CANCER: RESULTS FROM THE SEARCH DATABASE

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2018MP21-03 SERUM LIPID PROFILE AT TIME OF ANDROGEN DEPRIVATION THERAPY AND RISK OF CASTRATION-RESISTANT PROSTATE CANCER: RESULTS FROM THE SEARCH DATABASE Shweta Dambal, Lauren Howard, Emma Allott, William Aronson, Christopher Kane, Christopher Amling, Matthew Cooperberg, Martha Terris, and Stephen Freedland Shweta DambalShweta Dambal More articles by this author , Lauren HowardLauren Howard More articles by this author , Emma AllottEmma Allott More articles by this author , William AronsonWilliam Aronson More articles by this author , Christopher KaneChristopher Kane More articles by this author , Christopher AmlingChristopher Amling More articles by this author , Matthew CooperbergMatthew Cooperberg More articles by this author , Martha TerrisMartha Terris More articles by this author , and Stephen FreedlandStephen Freedland More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.694AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We previously showed that elevated serum triglycerides but not cholesterol, LDL or HDL in the year before radical prostatectomy (RP) were associated with increased risk of PSA recurrence. However, as cholesterol is the precursor for androgens and residual androgens are a key driver of castration-resistant prostate cancer (CRPC) after androgen deprivation therapy (ADT), we tested if lipid levels prior to ADT after RP were associated with CRPC risk. We hypothesized elevated cholesterol would increase CRPC risk. METHODS After excluding men who received statins prior to ADT, we identified 212 men in the SEARCH database with available serum lipid data within two years prior to ADT after RP. Lipids were treated as continuous and categorized as normal vs. abnormal (≥200 mg/dl for total cholesterol, ≥130 mg/dl for LDL, <40 mg/dl for HDL, ≥150 mg/dl for triglycerides). Cox models were used to test the association between lipids and CRPC risk after ADT. Models were adjusted for PSA at ADT, year of ADT, statin use after ADT as a time dependent covariate, and PSA doubling time at the time of ADT. In a subanalysis, we restricted models to men who never took statins even after ADT. RESULTS Median follow-up after ADT was 67 months (IQR 37-109) and 36 men developed CRPC. There were 148 (70%) men with cholesterol <200 and 64 (30%) with cholesterol ≥200 mg/dl. Men with elevated cholesterol had earlier years of surgery, longer follow-up, higher PSA at ADT, lower rate of post-RP radiation, higher rate of statin use after ADT, higher LDL, higher HDL, and higher triglycerides (all p≤0.01). Other disease characteristics were similar between groups. On multivariable analysis, there was no link between any lipid value and CRPC risk (all p>0.3). However, when restricting to men who never took a statin while on ADT, abnormal cholesterol was associated with increased CRPC risk on univariable analysis (HR 3.19, p=0.009). After adjustment, the association was attenuated and no longer significant, but the trend remained (HR 2.61, p=0.054). CONCLUSIONS Among men starting ADT who never took statins, high cholesterol was suggestively linked with increased CRPC risk. However, when including men who went on a statin after ADT, cholesterol was no longer linked with CRPC. This suggests that high cholesterol may be linked with CRPC and this excess risk is negated by statin use. Further studies are needed to confirm these findings and if confirmed, then to better understand the optimal timing of statin use to reduce CRPC. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e262-e263 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Shweta Dambal More articles by this author Lauren Howard More articles by this author Emma Allott More articles by this author William Aronson More articles by this author Christopher Kane More articles by this author Christopher Amling More articles by this author Matthew Cooperberg More articles by this author Martha Terris More articles by this author Stephen Freedland More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...