Statins may extend life in prostate cancer patients when taken with certain cancer treatments | Explained
A recent study suggests that cholesterol-lowering drugs, known as statins, may help men with advanced prostate cancer live longer, offering hope for improved treatment strategies. The study, published in the JAMA Network, analysed 2,187 men from the SPARTAN and TITAN trials— 2 other randomised clinical trials that looked at the effects of apalutamide, a prescription oral medication used to treat prostate cancer, on the metastatic and nonmetastatic kinds of the cancer and those that are resistant to hormone therapy. Researchers found that patients who took statins alongside apalutamide and standard hormone therapy had higher three-year survival rates compared to those not taking the anti-cholesterol drug along with the cancer treatments.
In the TITAN trial, statin users showed a 14 per cent higher survival rate, while the SPARTAN trial indicated an 8 per cent improvement. However, this benefit was observed only in patients taking apalutamide, with no improvement among those taking placebos.
Despite these promising findings, the study also highlighted potential risks. Statins were associated with an increased likelihood of severe heart events, classified as grade 3 or higher, which is particularly concerning for elderly prostate cancer patients who may already have cardiovascular conditions.
The study noted several limitations, and some findings could reflect "underlying bias and unmeasured confounding." The analysis had "inadequate power to detect between-group differences" and faced a higher risk of false discovery despite adjustments. Limited information on serial cholesterol levels, cumulative statin doses, and specific statin agents raises concerns about misclassification bias.
Potential drug-drug interactions between statins and apalutamide could not be explored, and concomitant statin use may reflect health-seeking behaviours that independently improve survival outcomes. Some patients were likely exposed to more than one class of medication, which was not analysed. Representation from racial and ethnic minority groups was extremely low, limiting the generalisability of the results. Overall, the study emphasises that its findings "should be interpreted with caution."
What does it mean for India?
Prostate cancer, caused by the uncontrolled growth of prostate cells, mainly affects older men and is often difficult to detect early because symptoms are mild or ignored. It presents a significant health burden worldwide. It is the second most commonly diagnosed cancer among men, the fifth leading cause of cancer-related mortality, and the fourth most common cancer globally. Between 1990 and 2019, the incidence, mortality, and disability-adjusted life years associated with prostate cancer rose sharply by 116.11 per cent, 108.94 per cent, and 98.25 per cent, respectively. In 2020, approximately 14.1 lakh new cases were reported globally, with nearly 3,58,989 deaths attributed to the disease in 2018 alone.
India ranks among the top ten countries with the highest incidence of prostate cancer, with an age-standardised incidence rate of 5.6 per 100,000, and it ranks fourth in mortality, with an age-standardised rate of 2.7 per 100,000 in 2022.
In India, efforts to improve male cancer care are being strengthened through initiatives like MenCan, launched by the Tata Memorial Centre. This programme focuses on prostate, penile, and testicular cancers, aiming to promote early detection, public awareness, patient support, and research. MenCan has introduced survivorship meetings, virtual support groups, a confidential helpline, and India’s first patient campus navigation app, while expanding outreach through social media. With rising prostate cancer diagnoses in India and high incidences of penile and testicular cancers, the initiative seeks to fill gaps in education, prevention, and care, with a long-term vision of extending its services across all Tata Memorial Centres.
At the policy level, Pradhan Mantri Jan Arogya Yojana (PMJAY) under Ayushman Bharat Mission, covers all urological disorder treatments, including prostate cancers.
However, as Dr Gaurav Jaswal, Director and Consultant Radiation Oncologist at TGH-Onco Life Cancer Centre, Maharashtra, pointed out, the situation is more nuanced. He highlighted the potential relevance of the recent statin study for India, noting that while hormonal therapies and other advanced prostate cancer treatments may not always be covered under government schemes, "if statins prove to be an affordable option, this could benefit a segment of the Indian population where people are price-conscious and cannot pay out of pocket for treatment."
Dr Jaswal also emphasised that although PMJAY does cover certain prostate cancer treatments, awareness about this coverage remains low. "PMJAY covers only Luprolyte, and sometimes it is not possible to give Luprolyte to patients who have cardiovascular risk factors. A better alternative may exist, but not everyone can afford it," he said, adding that the cardiovascular risks associated with statins must be carefully managed.
Addressing the study’s mention of cardiovascular risks associated with statins, Dr Jaswal emphasised the need for careful risk stratification. "We should find out whether there was an actual increased risk of heart disease through statins or if other factors are contributing," he said.
A 2022 review attributed the rising incidence of prostate cancer in India to factors such as "the increased migration of the rural population to urban areas, changing dietary and lifestyle habits, and increased awareness and easier access to medical facilities in urban areas."
Agreeing with this, Dr Jaswal explained that multiple factors contribute to the trend: "There is an increase in access to diagnostic modalities and healthcare, which means more cases are being detected that might have gone undiagnosed earlier," he said. He also highlighted demographic changes, noting that "although India has a young population, a significant portion is ageing, which naturally increases the number of prostate cancer cases."
Lifestyle changes post-liberalisation have also played a role. "Diets have changed, alcohol consumption has become more acceptable, and there is increased pressure to perform, leading to wrong lifestyle choices. India is the diabetic capital, and insulin resistance could be one of the reasons for the increase in prostate cancer cases," he said. Environmental factors such as pollution in the air, water, and food may also contribute. "Westernisation of lifestyle, diet, and urban living choices are all contributing factors," he added.
On challenges in early diagnosis, he explained that awareness remains low, particularly in rural areas. "Many people are unaware of prostate cancer symptoms, and they often consult non-allopathic practitioners or rely on over-the-counter medications. Organised screening programs are not yet widespread, unlike in the West, where men over 50 routinely undergo PSA testing."
Concluding with prevention and early detection, Dr Jaswal stressed the importance of a healthy lifestyle, including exercise, a balanced diet, and avoiding addictions. "Awareness should be promoted both by the government and private hospitals," he said, adding that educating general practitioners and primary care physicians to recognise prostate cancer symptoms and guide patients to proper investigations is crucial.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS.
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