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Serum cholesterol and risk of high-grade prostate cancer: results from the REDUCE study.

Abstract：

BACKGROUND:Epidemiologic evidence for a serum cholesterol-prostate cancer link is mixed. Prostate-specific antigen (PSA) is positively correlated with cholesterol, potentially increasing PSA-driven biopsy recommendations in men with high cholesterol, though biopsy compliance may be lower in men with comorbid conditions. These potential biases may affect PSA-driven biopsy rates and subsequent prostate cancer detection in men with high serum cholesterol. Our objective was to test the association between serum cholesterol and prostate cancer risk in men receiving PSA independent, study-mandated prostate biopsies. METHODS:We conducted a post hoc analysis of data from 4974 non-statin users in REDUCE, a randomized trial in men with elevated PSA and a negative baseline biopsy. Men underwent 2- and 4-year trial-mandated prostate biopsies. Associations between baseline serum levels of total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and prostate cancer risk, overall and by Gleason grade (<7 vs. ≥7), were examined using multivariable logistic regression. RESULTS:High total serum cholesterol was associated with an increased risk of high-grade prostate cancer diagnosis (OR per 10 mg/dL 1.05; 95% CI 1.00-1.09; p = 0.048), but cholesterol was unrelated to either overall or low-grade prostate cancer risk (p-values >0.185). There was no association between serum LDL and overall, low- or high-grade prostate cancer risk (p-values >0.137). In contrast, elevated serum HDL was associated with increased risk of both overall (OR per 10 mg/dL 1.08; 95% CI 1.01-1.16; p = 0.033) and high-grade prostate cancer (OR per 10 mg/dL 1.14; 95% CI 1.01-1.28; p = 0.034). CONCLUSIONS:In REDUCE, where all men received PSA independent, trial-mandated biopsies thus ensuring complete prostate cancer ascertainment, high total serum cholesterol and high HDL were associated with increased risk of high-grade prostate cancer, supporting a cholesterol-prostate cancer link.

journal_name

Prostate Cancer Prostatic Dis

journal_title

Prostate cancer and prostatic diseases

authors

Jamnagerwalla J,Howard LE,Allott EH,Vidal AC,Moreira DM,Castro-Santamaria R,Andriole GL,Freeman MR,Freedland SJ

doi

10.1038/s41391-017-0030-9

subject

Has Abstract

pub_date

2018-06-01 00:00:00

pages

252-259

issue

eissn

1365-7852

issn

1476-5608

pii

10.1038/s41391-017-0030-9

journal_volume

pub_type

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Serum cholesterol and risk of high-grade prostate cancer: results from the REDUCE study.