Abstract
Objectives
To analyze the influence of aspirin (ASA) intake on PSA values and prostate cancer (PCa) development in a prospective screening study cohort.
Methods
4314 men from the Swiss section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) were included. A transrectal prostate biopsy was performed in men with a PSA level ≥ 3 ng/ml. Mortality data were obtained through registry linkages. PCa incidence and grade, total PSA, free-to-total PSA and overall survival were compared between ASA users and non-users.
Results
Median follow-up time was 9.6 years. In 789 men (18.3%) using aspirin [ASA +], the overall PCa incidence was significantly lower (6.8% vs. 9.6%, p = 0.015), but the multivariate Cox regression analysis showed no significant decrease in risk of PCa diagnosis (HR 0.84, p = 0.297). Total PSA values were significantly lower in ASA users for both baseline (1.6 vs. 1.8 ng/ml, p = 0.007) and follow-up visits (1.75 vs. 2.1 ng/ml, p < 0.001). Multivariate Cox regression analysis predicted significantly higher overall mortality risk among ASA users (HR 1.46, p = 0.009).
Conclusions
In our study population, PCa incidence was significantly reduced among patients on aspirin. While we did not observe a statistically significant PCa risk reduction during the follow-up period, we found lower PSA values among ASA users compared to non-users, with a more distinct difference after 4 years of ASA intake, suggesting a cumulative effect and a potential protective association between regular ASA intake and PCa development. As for clinical practice, lowering PSA cutoff values by 0.4 ng/ml could be considered in long-term ASA users to avoid a potential bias towards delayed PCa detection.
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Acknowledgements
Prof. Lukas Bubendorf, Department of Pathology, University Hospital of Basel, Switzerland for pathology specimen review. Prof. emeritus Burkhart Seifert, Dept. of Epidemiology for assistance in statistical analysis. Financial support ERSPC Switzerland: The Horten Foundation, Aargau Cancer League, Swiss Cancer League (Grant Nr KFS 787-2-1999 and 01112-02-2001), Health Department of Canton Aargau, Prostate Cancer Research Foundation, Baugarten Foundation and the Messerli Foundation.
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LWP, LM and EL: study design, data analysis, manuscript writing. CM, SFW and TS: manuscript editing. RG and AH: data collection. FR, MK and DE: participated in designing the study, study coordination, data collection and supervision. All authors have critically reviewed the manuscript and have approved the final version submitted for publication.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee (Quality control of data collection for the ERSPC Switzerland (Aarau) was conducted under supervision within the ERSPC. The study protocol of the Swiss arm of the ERSPC was approved by the local ethical committee) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Prause, L.W., Manka, L., Millan, C. et al. Influence of regular aspirin intake on PSA values, prostate cancer incidence and overall survival in a prospective screening trial (ERSPC Aarau). World J Urol 38, 2485–2491 (2020). https://doi.org/10.1007/s00345-019-03054-5
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DOI: https://doi.org/10.1007/s00345-019-03054-5