Thousands of men pay regular homage to their PSA ( prostate specific antigen test ). For decades, health conscious men have been getting their periodic PSA test, the best test there is for prostate cancer screening. (Note that I have been there, done that and consider myself a success story.)
A simple blood test, a few days of waiting and finally a huge sigh of relief to learn that your PSA value has remained stable at some value under the magic number of 4. Millions of men participate in this more or less annual ritual and PSA levels have become acceptable topics for social conversation.
Recently it has been discovered that statin drugs appear to lower the likelihood of certain cancers, prostate cancer among them.
Naturally the drug companies lost no time in announcing this to the media with predictable results. Statins are not just for cholesterol anymore, they loudly proclaim, as if they could possibly improve upon past sales.
People are justifiably confused by this media whirlwind of disparate views and even their doctors are having trouble determining what happened to the old enemy, cholesterol, eggs and butter and who is this new kid on the block, inflammation? And how did it come to pass that we are using the same drug - statins?
"This effect of statins on prostate cancer is because of the anti-inflammatory effect of nuclear factor kappa B inhibition," doctors try to explain, not really understanding it themselves.
Ora Shovman knew it back it 2002 when he published it for all the world to see. It has taken this long for the drug companies to decide the best strategy to present this to doctors and patients.
Now enter Dr Stephen Freedland. His team, from Duke University School of Medicine, in North Carolina, found that men taking statins saw a drop in levels of their PSA test.
They examined the medical records of 1,214 men who were prescribed statins between 1990 and 2006 at the Durham Veterans Affairs Medical Center. The investigators compared PSA values taken up to two years before initiation of statin therapy and PSA values measured within one year after initiation of statin use.
The researchers saw a significant decline in PSA and low-density lipoprotein (LDL) in the participants and the PSA declines correlated with the magnitude of the LDL decrease. The decline in PSA also strongly correlated with the dose of statin.
The authors could not help but predict dire consequences to come if this PSA decline with statin use is confirmed in future studies. Not only will initial screening for prostate cancer, the third leading cause of death in men, be seriously compromised, so will follow-up of men already diagnosed and treated for prostate cancer.
As a specialist in preventive medicine I cannot think of a worse scenario to confront prostate cancer screening and this having nothing to do with cholesterol control and, likely, nothng to do with inflammation. This is one of those unexpected side effects raising its ugly head some 20 years after statins were first marketed and due to a completely unforeseen effect of statins on PSA enzyme synthesis.
How many time have I heard this about statins, reflecting that the statin class of drugs were marketed before fully understanding what they could do to our bodies. We are learning as we go along and that is not the way drugs should be developed.
Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor