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Improved survival with post-diagnostic metformin and statin use in a racially diverse cohort of US Veterans with advanced prostate cancer

Prostate Cancer and Prostatic Diseases volume 25, pages 707–712 (2022)Cite this article

Subjects

Abstract

Objective

To examine the association between post-diagnostic metformin or statin use with all-cause and prostate cancer (PCa)-specific mortality in men with advanced prostate cancer.

Methods

Our study consisted of 4572 men (Black = 1352, White = 3192, Other Race = 28) diagnosed with advanced cancer (T4/M1/N1) between 1999 and 2013 in the Veteran Health Administration. The association between post-diagnostic (1) metformin and (2) statin use with all-cause and PCa-specific mortality was examined using multivariable, time-varying Cox Proportional Hazard Models. In a secondary analysis, models were stratified by race.

Results

Post-diagnostic metformin use was associated with a reduced risk of all-cause (Hazard Ratio (HR) 0.84, 95% Confidence Interval (CI): 0.73, 0.96) and PCa-specific death (HR: 0.76, 95% CI: 0.63, 0.91). In stratified analyses, the inverse association between post-diagnostic metformin use and both all-cause PCa-specific mortality was limited to White men. Post-diagnostic statin use was associated with a reduced risk of all-cause (HR: 0.75, 95% CI: 0.68, 0.83) and PCa-specific mortality (HR: 0.72; 95% CI: 0.64, 0.81). In stratified analyses, similar inverse associations were observed for post-diagnostic statin use and all-cause and PCa-specific mortality in both Black and White men.

Conclusion

Post diagnostic metformin and statin use may prevent progression to lethal prostate cancer in men with advanced prostate cancer.

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Data availability

Access to VA data is governed by the VA and requires a Without Compensation (WOC) appointment through the VA.

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Funding

Funding

SK is supported and by the DOD grant W81XWH-18-1-0168 (PC170130). BFD is supported by the DOD grant W81XWH-19-1-0214 (PC131967). SK, BFD, and S-HC were supported by the Foundation of Barnes-Jewish Hospital and Siteman Cancer Center.

Author information

Authors and Affiliations

  1. Research Service, St. Louis Veterans Affairs Medical Center, St. Louis, MO, USA

    Saira Khan, Su-Hsin Chang, Veronica Hicks, Mei Wang & Bettina F. Drake

  2. Epidemiology Program, College of Heath Sciences, University of Delaware, Newark, DE, USA

    Saira Khan

  3. Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA

    Su-Hsin Chang, Veronica Hicks, Mei Wang & Bettina F. Drake

  4. Department of Urology, Medical University of South Carolina, Charleston, SC, USA

    Robert L. Grubb III

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  1. Saira Khan
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  4. Mei Wang
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Contributions

SK and BFD contributed to conception and design. S-HC contributed to the analytic strategy and made substantial contributions in interpreting the data. SK, MW, and VH conducted the data analyses. RLG provided clinical expertise and contributed to data interpretation. All authors assisted with drafting the manuscript and approved the final manuscript.

Corresponding author

Correspondence to Saira Khan.

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The authors declare no competing interests.

Ethical approval and consent to participate

IRB approval was received from the St. Louis VA Medical Center, Washington University, the Department of Defense, and the University of Delaware (via a reliance agreement with Washington University). A waiver of informed consent was received. The study was performed in accordance with the Declaration of Helsinki.

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Khan, S., Chang, SH., Hicks, V. et al. Improved survival with post-diagnostic metformin and statin use in a racially diverse cohort of US Veterans with advanced prostate cancer. Prostate Cancer Prostatic Dis 25, 707–712 (2022). https://doi.org/10.1038/s41391-021-00475-5

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