Use of Low-Dose Aspirin and Mortality After Prostate Cancer Diagnosis: A Nationwide Cohort Study

Ann Intern Med. 2019 Apr 2;170(7):443-452. doi: 10.7326/M17-3085. Epub 2019 Mar 5.


Background: Recent studies suggest that aspirin use may improve survival in patients with prostate cancer.

Objective: To assess the association between postdiagnosis use of low-dose aspirin and prostate cancer mortality.

Design: Nationwide cohort study.

Setting: Denmark.

Patients: Men with incident prostate adenocarcinoma between 2000 and 2011.

Measurements: Nationwide registry data on tumor characteristics, drug use, primary prostate cancer therapy, comorbidity, and socioeconomic parameters. Postdiagnosis use of low-dose aspirin (75 to 150 mg) was defined as 2 or more prescriptions filled within 1 year after prostate cancer diagnosis. Follow-up started 1 year after prostate cancer diagnosis. In secondary analyses, low-dose aspirin use was assessed within exposure periods of 5 or 7.5 years after prostate cancer diagnosis.

Results: Of 29 136 patients (median age, 70 years), 7633 died of prostate cancer and 5575 died of other causes during a median follow-up of 4.9 years (interquartile range, 3.1 to 7.2 years), through 2015. Postdiagnosis low-dose aspirin use was associated with adjusted hazard ratios (HRs) of 0.95 (95% CI, 0.89 to 1.01) for prostate cancer-specific mortality and 1.12 (CI, 1.05 to 1.20) for other-cause mortality. The secondary analyses showed that prostate cancer mortality was slightly reduced with low-dose aspirin use after the 5-year (HR, 0.91 [CI, 0.83 to 1.01]) and 7.5-year (HR, 0.84 [CI, 0.72 to 0.97]) postdiagnosis exposure periods, notably among patients filling prescriptions for a large quantity of low-dose aspirin tablets during the 7.5-year period.

Limitations: Data on over-the-counter aspirin use were unavailable. Some residual confounding was possible as a result of incomplete data on some prognostic factors.

Conclusion: The study did not support an overall effect of postdiagnosis low-dose aspirin use on prostate cancer mortality. However, results for extended exposure periods suggest that low-dose aspirin use might be inversely associated with prostate cancer mortality after 5 years from cancer diagnosis.

Primary funding source: Danish Cancer Society.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenocarcinoma / diagnosis
  • Adenocarcinoma / mortality*
  • Adenocarcinoma / pathology
  • Adult
  • Age of Onset
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage*
  • Aspirin / administration & dosage*
  • Cause of Death
  • Cohort Studies
  • Denmark / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Proportional Hazards Models
  • Prostatic Neoplasms / diagnosis
  • Prostatic Neoplasms / mortality*
  • Prostatic Neoplasms / pathology
  • Registries
  • Risk Factors


  • Anti-Inflammatory Agents, Non-Steroidal
  • Aspirin