Top doctors discuss the role of statins in prostate cancer

Top doctors discuss the role of statins in prostate cancer

Men’s Health Week (9th – 15th June) is here, and with this in mind, medical experts turn towards the most common form of cancer in men in the UK: prostate cancer - with particular reference to the role played by statins.

There has been a great deal of recent controversy surrounding statins with reference to whether or not they are beneficial for heart health - however new and interesting research demonstrates that they may in fact prevent the spread of prostate cancer.

We’ve been working with Dr Balvinder Wasan, Consultant Cardiologist and Mr Gordon Muir, Consultant Urological Surgeon at London Bridge Hospital to shed some light on the recent controversy to determine the role played by statins on the development of the cancer.

Dr Balvinder Wasan first explains how statins may play a part: “Statins seem to interfere with the process of prostate cancer cells entering the bone. The key seems to be a fatty acid called arachidonic acid (AA), which is found in high concentrations in the bone. This substance attracts prostate cancer cells & promotes their entry into the bone by encouraging changes in the cell shape. Statins interfere with the AA interaction with the cancer cells, making it harder for them to enter the bone. Once prostate cancer has spread, it is much more difficult to treat & therefore outcomes are worse.”

Mr Gordon Muir highlights the contradictions in research and the detriments of ambiguity, “Recent studies into the impact of statins on the development of prostate cancer are interesting  – but the jury is still out on whether statins could prevent the spread of prostate cancer, or in fact accelerate it. What we currently know is that prostate cancer behaviour can be modified by statins, but whether this is positive or negative is still a grey area. One of the problems in this area is the lack of certainty - if one looks at men with high cholesterol, then they are probably more likely to be fat meat-eaters, and thus more prone to get prostate cancer, than men who are skinny and vegetarian – but it is difficult to disentangle the cause and effect from the simple observational studies that have been done in the past.

“From the point of view of statins, if you have moderate to high cholesterol, you should probably be on statins to control this, and while we may well see evidence of the impact of statins against prostate cancer in the future, there is currently too much contradictory research. The current research is extremely clever and elegant, but is so far only limited to animal-based laboratory studies, which cannot be applied to humans.”

Mr Muir continues, providing advice for men on how to reduce their risk factors: “In terms of potential modifying behaviour, I would advise men to not eat too much red and processed meat, eat plenty of red and green vegetables, consider soya, and to limit the intake of saturated animal fat – but the most important component of prostate cancer development is family and racial history. Having a family history of aggressive prostate cancer means you are much more likely to develop it. Similarly, black men are three times more likely than white men or Asian men to develop the disease. My advice would be to be aware of your risk profile based on your family history, and if you are at a higher risk then you should consider having an earlier screening. Also remember that a healthy heart diet is a healthy prostate diet.

To continue the fight against death rates of prostate cancer, Mr Muir argues the need for a more accurate approach to diagnostics: “The focus now should be on having an extremely accurate diagnostics strategy to give men a much better idea of their diagnosis, and lowering the risk of aggressive prostate cancer growth. The urology teams at King's Health Partners and at London Bridge Hospital have been working on new diagnostics tests using MRI scanning and new biopsy techniques, to determine which patients have clinically significant prostate cancer, and which are at a lower risk. Our new diagnostic and enhanced biopsy pathway seems significantly more accurate than the traditional way of investigating men with possible prostate cancer, and should allow us to minimise unnecessary treatments.”

“Traditional diagnosis relies on a limited biopsy through the rectal skin. This biopsy has a small risk of serious infection, reaches only some of the prostate, and is imperfect from the point of view both of diagnosing but also excluding tumours. After a biopsy it is virtually impossible to make sense of an MRI scan for a few months."

Mr Muir concludes: “Our approach now is to carry out assessment of a man's symptoms, his overall fitness, and then to carry out a multi parametric MRI scan. If this test is entirely normal then a biopsy may not be needed. Should an abnormality be seen on the MRI scan then a much more accurate form of biopsy, which can reach every part of the prostate, is often recommended. If need be, the MRI images can be fused with the ultrasound and targeted biopsies taken. This approach gives a much higher degree of confidence in the accuracy of a positive biopsy, and also more certainty we have not missed anything if the biopsy is negative.”

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