Serum cholesterol and prostate cancer risk in the Finnish randomized study of screening for prostate cancer



Hypercholesterolemia has been associated with advanced stage prostate cancer (PCa), but the role of lipid parameters such as HDL and triglycerides is unclear. We examined PCa risk by lipid parameters in a population nested within the Finnish Randomized Study of Screening for Prostate Cancer (FinRSPC).


Cholesterol measurements were available on 17,696 men. During the 17-year median follow-up, 2404 PCa cases were diagnosed. Cox regression model was used to estimate hazard ratios (HR) and their 95% confidence intervals (95% CI) for overall PCa risk and stratified by Gleason grade and tumor stage. We compared normolipidemic and hyperlipidemic men on four cholesterol parameters total cholesterol (TC), HDL, LDL, and triglycerides (TG), analyzed as time-dependent variables.


TC in the highest tertile (above 5.1 mmol/l) and LDL above 3 mmol/l were associated with increased risk of Gleason 8–10 cancer (HR 1.42, 95% CI 1.04–1.95 and HR 1.38, 95% CI 1.02–1.86, respectively). Further, overall PCa risk was elevated in the 3-year lag time analysis by TC in the highest two tertiles (HR 1.27, 95% CI 1.05–1.54 for TC above 4.4 mmol/l, and HR 1.26, 95% CI 1.05–1.51 for TC above 5.1 mmol/l) and HDL in the highest tertile (HR 1.33, 95% CI 1.08–1.64) and above 1 mmol/l (HR 1.29, 95% CI 1.01–1.65). In contrast, TC in the highest tertile was associated with a decreased risk of PCa with 20-year lag time. The risk associations for overall PCa grew stronger with added lag time but were observed only in the FinRSPC control arm. Statin use did not modify the risk association.


Hypercholesterolemia may increase overall PCa risk in short-term, inverse risk association was observed with 20-years’ time lag. Similar risk increase of overall PCa was also observed for elevated HDL, conflicting with previous findings on the subject.

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Fig. 1


  1. 1.

    Krycer JR, Brown AJ. Cholesterol accumulation in prostate cancer: a classic observation from a modern perspective. Biochim Biophys Acta. 2013;1835:219–29.

    CAS  Google Scholar 

  2. 2.

    Di Vizio D, Solomon KR, Freeman MR. Cholesterol and cholesterol-rich membranes in prostate cancer: an update. Tumori. 2008;94:633–9.

    Article  Google Scholar 

  3. 3.

    Hager MH, Solomon KR, Freeman MR. The role of cholesterol in prostate cancer. Curr Opin Clin Nutr Metab Care. 2006;9:379–85.

    CAS  Article  Google Scholar 

  4. 4.

    Zadra G, Photopoulos C, Loda M. The fat side of prostate cancer. Biochim Biophys Acta. 2013;1831:1518–32.

    CAS  Article  Google Scholar 

  5. 5.

    Gathirua-Mwangi WG, Zhang J. Dietary factors and risk for advanced prostate cancer. Eur J Cancer Prev. 2014;23:96–109.

    CAS  Article  Google Scholar 

  6. 6.

    Clarke R, Frost C, Collins R, Appleby P, Peto R. Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. BMJ. 1997;314:112.

    CAS  Article  Google Scholar 

  7. 7.

    Whittemore AS, Kolonel LN, Wu AH, John EM, Gallagher RP, Howe GR, et al. Prostate cancer in relation to diet, physical activity, and body size in blacks, whites, and Asians in the United States and Canada. J Natl Cancer Inst. 1995;87:652–61.

    CAS  Article  Google Scholar 

  8. 8.

    Allott EH, Masko EM, Freedland SJ. Obesity and prostate cancer: weighing the evidence. Eur Urol. 2013;63:800–9.

    CAS  Article  Google Scholar 

  9. 9.

    Gong Z, Neuhouser ML, Goodman PJ, Albanes D, Chi C, Hsing AW, et al. Obesity, diabetes, and risk of prostate cancer: results from the prostate cancer prevention trial. Cancer Epidemiol Biomark Prev. 2006;15:1977–83.

    Article  Google Scholar 

  10. 10.

    His M, Zelek L, Deschasaux M, Pouchieu C, Kesse-Guyot E, Hercberg S, et al. Prospective associations between serum biomarkers of lipid metabolism and overall, breast and prostate cancer risk. Eur J Epidemiol. 2014;29:119–32.

    CAS  Article  Google Scholar 

  11. 11.

    Kitahara CM, Berrington de Gonzalez A, Freedman ND, Huxley R, Mok Y, Jee SH, et al. Total cholesterol and cancer risk in a large prospective study in Korea. J Clin Oncol. 2011;29:1592–8.

    CAS  Article  Google Scholar 

  12. 12.

    Martin RM, Vatten L, Gunnell D, Romundstad P, Nilsen TI. Components of the metabolic syndrome and risk of prostate cancer: the HUNT 2 cohort, Norway. Cancer Causes Control. 2009;20:1181–92.

    Article  Google Scholar 

  13. 13.

    Mondul AM, Clipp SL, Helzlsouer KJ, Platz EA. Association between plasma total cholesterol concentration and incident prostate cancer in the CLUE II cohort. Cancer Causes Control. 2010;21:61–68.

    Article  Google Scholar 

  14. 14.

    Jacobs EJ, Stevens VL, Newton CC, Gapstur SM. Plasma total, LDL, and HDL cholesterol and risk of aggressive prostate cancer in the Cancer Prevention Study II Nutrition Cohort. Cancer Causes Control. 2012;23:1289–96.

    Article  Google Scholar 

  15. 15.

    Van Hemelrijck M, Garmo H, Holmberg L, Walldius G, Jungner I, Hammar N, et al. Prostate cancer risk in the Swedish AMORIS study: the interplay among triglycerides, total cholesterol, and glucose. Cancer . 2011;117:2086–95.

    Article  Google Scholar 

  16. 16.

    Arthur R, Moller H, Garmo H, Holmberg L, Stattin P, Malmstrom H, et al. Association between baseline serum glucose, triglycerides and total cholesterol, and prostate cancer risk categories. Cancer Med. 2016;5:1307–18.

    CAS  Article  Google Scholar 

  17. 17.

    Heir T, Falk RS, Robsahm TE, Sandvik L, Erikssen J, Tretli S. Cholesterol and prostate cancer risk: a long-term prospective cohort study. BMC Cancer. 2016;16:643.

    Article  Google Scholar 

  18. 18.

    Kok DE, van Roermund JG, Aben KK, den Heijer M, Swinkels DW, Kampman E, et al. Blood lipid levels and prostate cancer risk; a cohort study. Prostate Cancer Prostatic Dis. 2011;14:340–5.

    CAS  Article  Google Scholar 

  19. 19.

    Platz EA, Clinton SK, Giovannucci E. Association between plasma cholesterol and prostate cancer in the PSA era. Int J Cancer. 2008;123:1693–8.

    CAS  Article  Google Scholar 

  20. 20.

    Platz EA, Till C, Goodman PJ, Parnes HL, Figg WD, Albanes D, et al. Men with low serum cholesterol have a lower risk of high-grade prostate cancer in the placebo arm of the prostate cancer prevention trial. Cancer Epidemiol Biomark Prev. 2009;18:2807–13.

    CAS  Article  Google Scholar 

  21. 21.

    Mondul AM, Weinstein SJ, Virtamo J, Albanes D. Serum total and HDL cholesterol and risk of prostate cancer. Cancer Causes Control. 2011;22:1545–52.

    Article  Google Scholar 

  22. 22.

    Salgado-Montilla J, Soto Salgado M, Surillo Trautmann B, Sanchez-Ortiz R, Irizarry-Ramirez M. Association of serum lipid levels and prostate cancer severity among Hispanic Puerto Rican men. Lipids Health Dis. 2015;14:111.

    Article  Google Scholar 

  23. 23.

    Ahn J, Lim U, Weinstein SJ, Schatzkin A, Hayes RB, Virtamo J, et al. Prediagnostic total and high-density lipoprotein cholesterol and risk of cancer. Cancer Epidemiol Biomark Prev. 2009;18:2814–21.

    CAS  Article  Google Scholar 

  24. 24.

    Van Hemelrijck M, Walldius G, Jungner I, Hammar N, Garmo H, Binda E, et al. Low levels of apolipoprotein A-I and HDL are associated with risk of prostate cancer in the Swedish AMORIS study. Cancer Causes Control. 2011;22:1011–9.

    Article  Google Scholar 

  25. 25.

    Borgquist S, Butt T, Almgren P, Shiffman D, Stocks T, Orho-Melander M, et al. Apolipoproteins, lipids and risk of cancer. Int J Cancer. 2016;138:2648–56.

    CAS  Article  Google Scholar 

  26. 26.

    Farwell WR, D’Avolio LW, Scranton RE, Lawler EV, Gaziano JM. Statins and prostate cancer diagnosis and grade in a veterans population. J Natl Cancer Inst. 2011;103:885–92.

    CAS  Article  Google Scholar 

  27. 27.

    Murtola TJ, Tammela TL, Maattanen L, Huhtala H, Platz EA, Ala-Opas M, et al. Prostate cancer and PSA among statin users in the Finnish prostate cancer screening trial. Int J Cancer. 2010;127:1650–9.

    CAS  Article  Google Scholar 

  28. 28.

    Murtola TJ, Peltomaa AI, Talala K, Maattanen L, Taari K, Tammela TLJ, et al. Statin use and prostate cancer survival in the Finnish Randomized Study of Screening for Prostate Cancer. Eur Urol Focus. 2017;3:212–20.

    Article  Google Scholar 

  29. 29.

    Crawford ED. Understanding the epidemiology, natural history, and key pathways involved in prostate cancer. Urology. 2009;73:S4–S10.

    Article  Google Scholar 

  30. 30.

    Checkoway H, Checkoway H, Pearce N, Pearce N, Hickey JLS, Hickey JLS, et al. Latency analysis in occupational epidemiology. Arch Environ Health. 1990;45:95–100.

    CAS  Article  Google Scholar 

  31. 31.

    Sarre S, Maattanen L, Tammela TL, Auvinen A, Murtola TJ. Postscreening follow-up of the Finnish Prostate Cancer Screening Trial on putative prostate cancer risk factors: vitamin and mineral use, male pattern baldness, pubertal development and non-steroidal anti-inflammatory drug use. Scand J Urol. 2016;50:1–7.

  32. 32.

    Dyslipidemia. Current Care Guidelines. Working group set up by the Finnish Medical Society Duodecim and Finnish Society of Internal Medicine. Helsinki: The Finnish Medical Society Duodecim, 2013. Accessed 30 Mar 2016.

  33. 33.

    Kilpelainen TP, Pogodin-Hannolainen D, Kemppainen K, Talala K, Raitanen J, Taari K, et al. Estimate of opportunistic prostate specific antigen testing in the Finnish Randomized Study of Screening for Prostate Cancer. J Urol. 2017;198:50–57.

    Article  Google Scholar 

  34. 34.

    YuPeng L, YuXue Z, PengFei L, Cheng C, YaShuang Z, DaPeng L, et al. Cholesterol levels in blood and the risk of prostate cancer: a meta-analysis of 14 prospective studies. Cancer Epidemiol Biomark Prev. 2015;24:1086–93.

    Article  Google Scholar 

  35. 35.

    Murtola TJ, Syvala H, Pennanen P, Blauer M, Solakivi T, Ylikomi T, et al. The importance of LDL and cholesterol metabolism for prostate epithelial cell growth. PLoS One. 2012;7:e39445.

    CAS  Article  Google Scholar 

  36. 36.

    Wan F, Qin X, Zhang G, Lu X, Zhu Y, Zhang H, et al. Oxidized low-density lipoprotein is associated with advanced-stage prostate cancer. Tumour Biol. 2015;36:3573–82.

    CAS  Article  Google Scholar 

  37. 37.

    Schorghofer D, Kinslechner K, Preitschopf A, Schutz B, Rohrl C, Hengstschlager M, et al. The HDL receptor SR-BI is associated with human prostate cancer progression and plays a possible role in establishing androgen independence. Reprod Biol Endocrinol. 2015;13:88.

    Article  Google Scholar 

  38. 38.

    Gutierrez-Pajares JL, Ben Hassen C, Chevalier S, Frank PG. SR-BI: linking cholesterol and lipoprotein metabolism with breast and prostate cancer. Front Pharmacol. 2016;7:338.

    Article  Google Scholar 

  39. 39.

    Sekine Y, Demosky SJ, Stonik JA, Furuya Y, Koike H, Suzuki K, et al. High-density lipoprotein induces proliferation and migration of human prostate androgen-independent cancer cells by an ABCA1-dependent mechanism. Mol Cancer Res. 2010;8:1284–94.

    CAS  Article  Google Scholar 

  40. 40.

    Kotani K, Sekine Y, Ishikawa S, Ikpot IZ, Suzuki K, Remaley AT. High-density lipoprotein and prostate cancer: an overview. J Epidemiol. 2013;23:313–9.

    Article  Google Scholar 

  41. 41.

    Tall AR. Exercise to reduce cardiovascular risk—how much is enough? N Engl J Med. 2002;347:1522–4.

    Article  Google Scholar 

  42. 42.

    Lamon-Fava S, Wilson PWF, Schaefer EJ. Impact of body mass index on coronary heart disease risk factors in men and women. Arterioscler Thromb Vasc Bio. 1996;16:1509–15.

    CAS  Article  Google Scholar 

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Correspondence to Teemu J. Murtola.

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Conflict of interest

The manuscript was supported by a competitive research grant from the Expert Responsibility Area of The Pirkanmaa Hospital District to TJM. Dr. TJM has worked as a paid consultant for Astellas and Janssen-Cilag and received lecture fees from Astellas, Janssen-Cilag, Abbvie and MSD. Dr. KT has received consulting fees from Abbvie, research funding from Medivation, and travel support from Astellas, and Orion. Professor TLJT has worked as a paid consultant for Astellas and Janssen-Cilag, and received lecture fees from Astellas, Janssen-Cilag, Abbvie and MSD. Professor AA has received a lecture fee from MSD, and worked as a paid consultant for Epid Research Inc. The remaining authors declare that they have no conflict of interest.

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Murtola, T.J., Kasurinen, T.V.J., Talala, K. et al. Serum cholesterol and prostate cancer risk in the Finnish randomized study of screening for prostate cancer. Prostate Cancer Prostatic Dis 22, 66–76 (2019).

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