Aspirin use decreases the risk of prostate cancer recurrence after post-prostatectomy radiotherapy
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The objective of the study is to determine if aspirin use is associated with decreased risk of biochemical failure, distant metastasis, and prostate cancer specific mortality in prostate cancer patients after adjuvant or salvage radiation therapy following radical prostatectomy.
We identified 189 men with pathologic T2a-4a, N0/X, M0 prostate adenocarcinoma who received adjuvant or salvage radiation therapy following prostatectomy. Aspirin use (defined as use at time of radiation therapy or during follow-up) was present in 60 men (32 %). Cox multivariate analysis was performed using Kaplan-Meier estimation and log-rank test with the following covariates: pre-radiation therapy prostate-specific antigen, Gleason score, prostate-specific antigen doubling time, warfarin or clopidogrel use, aspirin use, surgical margin status, radiation dose, time interval from prostatectomy to radiation therapy, and radiation technique.
The median follow-up time was 50 months. Aspirin use was associated with improved 5-year rates of prostate-specific antigen nadir + 2 ng/mL biochemical failure (15 vs. 42 %, p = 0.002), distant metastases (0 vs. 8 %, p = 0.02), and prostate cancer-specific mortality (0 vs. 5 %, p = 0.14). On multivariate analysis, aspirin nonuse (hazard ratio = 2.9, 95 % confidence interval = 1.3–6.6) was the only predictor for prostate-specific antigen nadir + 2 ng/mL biochemical failure.
In patients who received adjuvant and salvage radiation therapy after primary radical prostatectomy, aspirin use was associated with a decreased risk of biochemical failure.
KeywordsProstate cancer Radiotherapy Prostatectomy Aspirin Anticoagulant
Three-dimensional conformal radiotherapy
Adult Comorbidity Evaluation-27
Androgen deprivation therapy
Prostate cancer-specific mortality
The study was presented at 53rd Annual Meeting of the American Society for Radiation Oncology, 2–6 October 2011, Miami, FL. This publication was supported by grant number P30 CA006927 from the National Cancer Institute/NIH and a departmental Varian Grant. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, or Varian. The authors thank Dr. Gerald Hanks for his leadership in the establishment of the Fox Chase Cancer Center database for the treatment of prostate cancer.
Conflict of interest
None of the authors (Nicholas G. Zaorsky, M.D.; Tianyu Li, M.S.; Randi J. Cohen, M.D., M.S.; Eric M. Horwitz, M.D.; Robert G. Uzzo, M.D.; Rosalia Viterbo, M.D.; Mark K. Buyyounouski, M.D., M.S.) has any financial relationship with the organization that sponsored the research. None of the authors (Nicholas G. Zaorsky, M.D.; Tianyu Li, M.S.; Randi J. Cohen, M.D., M.S.; Eric M. Horwitz, M.D.; Robert G. Uzzo, M.D.; Rosalia Viterbo, M.D.; Mark K. Buyyounouski, M.D., M.S.) has any conflict of interest.
All authors (Nicholas G. Zaorsky, M.D.; Tianyu Li, M.S.; Randi J. Cohen, M.D., M.S.; Eric M. Horwitz, M.D.; Robert G. Uzzo, M.D.; Rosalia Viterbo, M.D.; Mark K. Buyyounouski, M.D., M.S.) have read and approved the manuscript. We have no financial disclosures. We are not using any copyrighted information, patient photographs, identifiers, or other protected health information in this paper. No text, text boxes, figures, or tables in this article have been previously published or owned by another party. This study was approved by the IRB, protocol number IRB 03-835. This study has been approved by the appropriate ethics committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study. This is a retrospective study, and this article does not contain any studies with human subjects performed by any of the authors. This manuscript is not under consideration elsewhere.