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

• Published in: Prostate cancer and prostatic diseases Vol. 25; no. 4; pp. 707 - 712
• Main Authors: Khan, Saira, Chang, Su-Hsin, Hicks, Veronica, Wang, Mei, Grubb, 3rd, Robert L, Drake, Bettina F
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.04.2022
• Subjects: Antidiabetics; Cohort Studies; Diagnostic systems; Health hazards; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Metformin; Metformin - therapeutic use; Mortality; Proportional Hazards Models; Prostate cancer; Prostatic Neoplasms - diagnosis; Prostatic Neoplasms - drug therapy; Prostatic Neoplasms - epidemiology; Risk management; Risk reduction; Secondary analysis; Statistical models; Veterans; White people
• ISSN: 1365-7852; 1476-5608
• DOI: 10.1038/s41391-021-00475-5

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