Additional Cause for Concern?

Swingshiftworker

I was reading an old thread regarding PSA testing here -- "Another View On PSA Testing" -- which reminded me that certain drugs can affect PSA test results.

So, I did a simple Google search for two of the drugs that I take daily (and their possible effects on PSA) -- aspirin and a statin to prevent heart disease and lower cholesterol, respectively -- and I suspect that many other men w/PCa also take these drugs.

Lo and behold, this is what I found:

"Statins, Aspriin May Hide Prostate Cancer."

Originally published September 2010; last reviewed March 16, 2011 in "Harvard Medical School + Harvard Health Publications, Prostate Knowledge."

See: http://www.harvardprostateknowledge.org/statins-aspirin-may-hide-prostate-cancer

The text of the article follows below.

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"Most men learn that they have prostate cancer after a blood test shows elevated prostate-specific antigen (PSA) levels, prompting a biopsy. A high or rising PSA can also signal the return of cancer following surgery or radiation therapy. Drugs that artificially lower PSA levels could, at least in theory, obscure elevations that offer early warnings of a problem.

One recent study linked the use of cholesterol-lowering drugs called statins to reduced PSA levels. Researchers looked at PSA levels among 1,214 military veterans before and after they started taking a statin. With statins, the median decline in PSA was 4.1%, and changes in PSA were strongly associated with the statin dose and changes in LDL cholesterol, the “bad” cholesterol.

In another study, presented at a meeting of the American Association for Cancer Research last fall, Vanderbilt University researchers reported that participants in the Nashville Men’s Health Study who regularly took aspirin had PSA levels that were 9% lower on average than those in men who didn’t take aspirin. (Data from this trial have not yet been published in a scientific or medical journal.)

The changes in PSA in these studies weren’t large. But researchers expressed concern that the drugs could mask fluctuations in PSA that might interfere with the detection of prostate cancer. Another tantalizing possibility is that statins and aspirin fight prostate cancer. But it would take some very large, very long trials to determine if that is the reason for the decrease in PSA.

Given these findings, make sure to tell your urologist if you are taking statins, aspirin, or both. Also, track changes in your PSA over time to help ensure you aren’t harboring prostate cancer.

SOURCE: Hamilton RJ, Goldberg KC, Platz EA, Freedland SJ. The Influence of Statin Medications on Prostate-Specific Antigen Levels. Journal of the National Cancer Institute 2008;100:1511–18. PMID: 18957682"

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If this is correct, I and many men who commonly take these drugs may actually have higher PSA scores than measured and, in my case, this makes my higher post-CK treatment PSA level an even greater cause for concern -- unless, of course, the suggestion that statins & aspirin may actually "cure" PCa has validity.

It would be SO nice to have a better measure of PCa than PSA but it's all we have for the time being and we all have to live with it's inaccuracies and contradictions.

Oh well . .

PawPaw J

Swing, I also have heard
Swing, I also have heard that statement within the last couple of months. I was taking simvastatin for high cholesterol prior to my surgery on Aug 9th and stopped taking it. I had also read somewhere that statins could also feed cancer cells. Either way I have not taken anything for my cholesterol and going next week to get cholesterol rechecked to see if my diet has helped any. Have lost 28 lbs since surgery. Cut fat, sugar and sodium 80% so hopefully thats going to be better than meds. Also my first post op psa today was less than 0.03 so at least I know the simvastatin was not masking the reading.

Johnny

VascodaGama

PawPaw J said:

Swing, I also have heard
Swing, I also have heard that statement within the last couple of months. I was taking simvastatin for high cholesterol prior to my surgery on Aug 9th and stopped taking it. I had also read somewhere that statins could also feed cancer cells. Either way I have not taken anything for my cholesterol and going next week to get cholesterol rechecked to see if my diet has helped any. Have lost 28 lbs since surgery. Cut fat, sugar and sodium 80% so hopefully thats going to be better than meds. Also my first post op psa today was less than 0.03 so at least I know the simvastatin was not masking the reading.

Johnny

Should we be concerned with a Masking Theory ?
I take Aspirin (100mg/day) since 2001 (post surgery). Data from 5 years of my status has been used in a long study on the effects of aspirin in prostate cancer. There are many articles on the subject, being one, recently published, and indicating that aspirin taken with milk have shown better “benefits”.

However, Aspirin in my case of eleven years has proven to be not the way for curing PCa. How far it has slowed down its progress it is questionable too. A relationship between its use and the progress of PSA readings shows that it did not stop or modify the curve in my PSA graph. Along the years on aspirin I have taken quarterly tests, all of them nearly under the same conditions as the “baseline” (aspirin, reliable laboratory assay, no apparent effect from other possible sources or compounds, etc.).

The importance of PSA in prostate cancer in regards to the free PSA % is that one reading alone does not indicate the whole of the diagnosis. But the trend in PSA (past chronology) tells us everything. It is with such data that nomograms are prepared and where studies analyse its reliance. Doctors use those numbers to set their thresholds of treatments which rely much on PSA velocity, doubling times and past treatment type.

The use of a solo PSA as the “measurement” to lead to a treatment is in my opinion erroneous. A PSA of 3 which is considered within the “normal range” in standards is not normal at all if that value belongs to a graph indicating a progression of PSADT lower than 14 months.

The article in the link of Swing is clear to the evidence that other measurements are necessary to avoid any form of “…masked fluctuations in PSA that might interfere with the detection of prostate cancer…” or even other effects that would provide an erroneous decision.
I would correct their sentence to something like this; “Drugs that artificially lower PSA levels could, at least in theory, obscure elevations that offer early warnings of a problem….. so that physicians should not use a solo measurement to get to decisions”.
Nevertheless, we survivors know well that this “masking theory” does not take place in the real practice of the management of our disease and its progress.

A PSA test is valid even if one is taking statins, aspirin or other nonsteroidal antiinflammatory drugs (NSAIDs). Their influence in the context of a diagnosis (of 10%) is minimal whether our baseline is at levels of 0.01 or above 4.0.

Regards
VGama

VascodaGama

PawPaw J said:

Swing, I also have heard
Swing, I also have heard that statement within the last couple of months. I was taking simvastatin for high cholesterol prior to my surgery on Aug 9th and stopped taking it. I had also read somewhere that statins could also feed cancer cells. Either way I have not taken anything for my cholesterol and going next week to get cholesterol rechecked to see if my diet has helped any. Have lost 28 lbs since surgery. Cut fat, sugar and sodium 80% so hopefully thats going to be better than meds. Also my first post op psa today was less than 0.03 so at least I know the simvastatin was not masking the reading.

Johnny

Congratulations to Johnny (PawPaw J)
It is wonderful to know about your first PSA post RP (august, open surgery) of 0.03. My surgeon of 2000 used a threshold of 0.06 as remission for RP. Unfortunately mine was 0.18 which leaded to a recurrence diagnosis at 0.26 less than six months post op.
I am glad to know that you are having a symptomless recovery and dry from day one.
I hope that ED returns to its normalcy the soonest.

Wishing you the best.
VGama

PawPaw J

VascodaGama said:

Congratulations to Johnny (PawPaw J)
It is wonderful to know about your first PSA post RP (august, open surgery) of 0.03. My surgeon of 2000 used a threshold of 0.06 as remission for RP. Unfortunately mine was 0.18 which leaded to a recurrence diagnosis at 0.26 less than six months post op.
I am glad to know that you are having a symptomless recovery and dry from day one.
I hope that ED returns to its normalcy the soonest.

Wishing you the best.
VGama

How do you remember
VGama, Thanks for the kind words,BUT how do you remember all the details of so many people. I will see you respond to someone with their history when it has not been posted in awhile. I know I put some of my details on the board but not in the last few post. When I read post from everyone I wonder what the history is , which tx they had and their dx to start and I cant remember and have trouble finding it. Any suggestions?

Johnny

VascodaGama

PawPaw J said:

How do you remember
VGama, Thanks for the kind words,BUT how do you remember all the details of so many people. I will see you respond to someone with their history when it has not been posted in awhile. I know I put some of my details on the board but not in the last few post. When I read post from everyone I wonder what the history is , which tx they had and their dx to start and I cant remember and have trouble finding it. Any suggestions?

Johnny

Johnny; It is no secret
I am not a brainer. I simply write in my note book some guys name and treatment with which I compare what I read in some studies. I do not keep details but key information and the title of my post.
You can find your threads or posts using google. You have posted your treatment in a thread where I posted my comment under the title “Biased Comment? Maybe not !”. Googling this sentence with the CSN word gave me this link;
http://csn.cancer.org/node/225094
The forum search engine is helpless.

Just try.
VG