Aspirin and Non-Aspirin NSAID Use and Prostate Cancer Incidence, Mortality, and Case-Fatality in the Atherosclerosis Risk in Communities Study
Menée aux Etats-Unis à partir de données portant sur 6 594 hommes sans antécédent de cancer lors de leur inclusion entre 1987 et 1989, cette étude de cohorte évalue l'association entre une utilisation d'aspirine et d'anti-inflammatoires non stéroïdiens, le risque de développer un cancer de la prostate et la mortalité spécifique
Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) appear to moderately reduce prostate cancer risk. However, evidence is limited on whether NSAIDs protect against prostate cancer mortality (death from prostate cancer among men without a cancer history) and case-fatality (death from prostate cancer among men with prostate cancer), and whether benefits are consistent in white and black men. This study investigated associations of aspirin and non-aspirin (NA)-NSAID use with prostate cancer incidence, mortality, and case-fatality in a population-based cohort of white and black men. Methods: We included 6,594 men (5,060 white, 1,534 black) from the Atherosclerosis Risk in Communities study without a cancer history at enrollment in 1987-89. NSAID use was assessed at four study visits (1987-98). Cancer outcomes were ascertained through 2012. Cox proportional hazards regression was used to estimate adjusted hazard ratios (HRs), overall and by race. Results: Aspirin use was not associated with prostate cancer incidence. However, aspirin use was inversely associated with prostate cancer mortality (HR: 0.59, 95% confidence interval [CI]: 0.36-0.96). This association was consistent among white and black men and appeared restricted to men using aspirin daily and/or for cardiovascular disease prevention. Aspirin use was inversely associated with case-fatality (HR: 0.45, 95% CI: 0.22-0.94). NA-NSAID use was not associated with these endpoints. Conclusions: Aspirin use was inversely associated with prostate cancer mortality and case-fatality among white and black men. Impact: If confirmed by additional studies, benefits of aspirin for preventing prostate cancer mortality may need to be factored into risk-benefit calculations of men considering an aspirin regimen.