Prostate Cancer Recurrence After Surgery Linked to High Lipids

Elevated triglyceride levels are associated with an increased risk of prostate cancer (PCa) recurrence after radical prostatectomy (RP), according to a recent study.

In a retrospective study of 843 RP patients who never used statins prior to surgery, lead author Emma H. Allott, PhD, and senior author Stephen J. Freedland, MD, both of Duke University School of Medicine in Durham, N.C., and colleagues found that patients who had abnormal triglyceride levels (150 mg/dL or higher) had a significant 35% increased risk of biochemical recurrence (BCR) compared with those who had levels below 150 mg/dL in adjusted analyses.

Additionally, results showed that each 10 mg/dL increment in serum triglycerides was associated with a significant 2% increased risk of BCR.

The investigators observed no associations between BCR risk and total cholesterol and low- and high-density lipoproteins (LDL and HDL, respectively). Among men with dyslipidemia, however, each 10 mg/dL increment in cholesterol and HDL was associated with a significant 9% increased risk of recurrence and 39% decreased risk of recurrence, respectively, the investigators reported online ahead of print in Cancer Epidemiology, Biomarkers & Prevention.

“These findings, coupled with evidence that statin use is associated with reduced recurrence risk, suggest that lipid levels should be explored as a modifiable risk factor for prostate cancer recurrence,” the authors concluded.

The researchers analyzed data captured in the Shared Equal Access Regional Cancer Hospital (SEARCH) database. They defined dyslipidemia using National Cholesterol Education Program guidelines. Of the 843 patients, 325 (39%) had abnormal preoperative cholesterol levels (200 mg/dL or higher) and 293 (35%) experienced BCR, defined as a single PSA value greater than 0.2 ng/mL, 2 consecutive PCa measures of 0.2 ng/mL, or secondary treatment for detectable post-operative PSA.

In a discussion of study limitations, the researchers noted that all serum lipid measurements were obtained within the year prior to RP, so these measurements might have been affected by the presence of preclinical disease. 

The study lacked sufficient numbers to explore the impact of abnormal levels of all 4 lipids simultaneously on PCa recurrence, and the researchers did not have access to hypertension data, so they could not evaluate the association between metabolic syndrome and recurrence risk.

In a previous study of 1,146 RP patients who did not take statins preoperatively, Dr. Allott, Dr. Freedland, and colleagues found that post-operative use of statins was associated with a significant 36% decreased risk of BCR, after adjusting for clinical and pathologic characteristics, according to findings published online ahead of print in BJU International.

When the investigators stratified findings according to race, they found that post-operative statin use was associated with a significant 51% decreased risk of BCR among non-black patients and a non-significant 18% decreased risk among blacks.

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