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Meta-Analysis
. 2017 Jul;10(7):410-420.
doi: 10.1158/1940-6207.CAPR-17-0033. Epub 2017 May 15.

Do Aspirin and Other NSAIDs Confer a Survival Benefit in Men Diagnosed With Prostate Cancer? A Pooled Analysis of NIH-AARP and PLCO Cohorts

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Meta-Analysis

Do Aspirin and Other NSAIDs Confer a Survival Benefit in Men Diagnosed With Prostate Cancer? A Pooled Analysis of NIH-AARP and PLCO Cohorts

Cindy Ke Zhou et al. Cancer Prev Res (Phila). .
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Abstract

Prostate cancer is one of the leading causes of cancer-related death in U.S. men. There is an unmet need to identify modifiable risk factors for prostate cancer survival. Experimental studies have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may improve prostate cancer survival through antithrombotic and anti-inflammation mechanisms. Results from previous observational studies have been equivocal, and few have assessed whether an etiologically relevant time window of exposure exists. We sampled incident prostate cancer cases from two large U.S. prospective cohorts, NIH-AARP Diet and Health Study and PLCO Cancer Screening Trial, to investigate whether pre- and postdiagnostic aspirin and non-aspirin NSAID use were associated with prostate cancer-specific and all-cause mortality. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Study-specific results were meta-analyzed using fixed-effects models. Pre- and postdiagnostic aspirin or non-aspirin NSAID use were not statistically significantly associated with prostate cancer-specific mortality. However, occasional (less than daily) and daily aspirin users five years or more before prostate cancer diagnosis had 18% (HR = 0.82; 95% CI = 0.75-0.90) and 15% (HR = 0.85; 95% CI = 0.77-0.94) reduced all-cause mortality versus nonusers. Similarly, postdiagnostic occasional and daily aspirin use were associated with 17% (HR = 0.83; 95% CI=0.72-0.95) and 25% (HR = 0.75; 95% CI = 0.66-0.86) reduced all-cause mortality, independent of prediagnostic aspirin use. This study suggests that aspirin or non-aspirin NSAIDs are not associated with prostate cancer survival. However, aspirin use both before and after prostate cancer diagnosis was associated with longer overall survival, highlighting the importance of comorbidity prevention among prostate cancer survivors. Cancer Prev Res; 10(7); 410-20. ©2017 AACR.

Conflict of interest statement

Conflict of interest: The authors declare that there is no conflict of interest.

Figures

Figure 1
Figure 1. Timeline of data collection and survival follow-up in NIH-AARP and PLCO
The dashed line indicates the time interval from exposure ascertainment to prostate cancer diagnosis in HIH-AARP and PLCO, the dotted line indicates the lag time and the solid line indicates the follow-up time in the model. The shaded area indicates exposures of interest. Therefore, for the pre-diagnostic analysis, follow-up started at the age of prostate cancer diagnosis and ended at the age of death due to the cause of interest or right censoring, whichever occurred earlier. For the post-diagnostic analysis, follow-up started at the age of SQX/FUQ and ended at the age of death due to the cause of interest or right-censoring, whichever occurred earlier. RFQ, Risk Factor Questionnaire; FUQ, Follow-up Questionnaire; BQM, Baseline Questionnaire for Men; SQX, Supplemental Questionnaire; CaP, prostate cancer; PCSM, prostate cancer-specific mortality.

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