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Influence of regular aspirin intake on PSA values, prostate cancer incidence and overall survival in a prospective screening trial (ERSPC Aarau)

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Abstract

Objectives

To analyze the influence of aspirin (ASA) intake on PSA values and prostate cancer (PCa) development in a prospective screening study cohort.

Methods

4314 men from the Swiss section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) were included. A transrectal prostate biopsy was performed in men with a PSA level ≥ 3 ng/ml. Mortality data were obtained through registry linkages. PCa incidence and grade, total PSA, free-to-total PSA and overall survival were compared between ASA users and non-users.

Results

Median follow-up time was 9.6 years. In 789 men (18.3%) using aspirin [ASA +], the overall PCa incidence was significantly lower (6.8% vs. 9.6%, p = 0.015), but the multivariate Cox regression analysis showed no significant decrease in risk of PCa diagnosis (HR 0.84, p = 0.297). Total PSA values were significantly lower in ASA users for both baseline (1.6 vs. 1.8 ng/ml, p = 0.007) and follow-up visits (1.75 vs. 2.1 ng/ml, p < 0.001). Multivariate Cox regression analysis predicted significantly higher overall mortality risk among ASA users (HR 1.46, p = 0.009).

Conclusions

In our study population, PCa incidence was significantly reduced among patients on aspirin. While we did not observe a statistically significant PCa risk reduction during the follow-up period, we found lower PSA values among ASA users compared to non-users, with a more distinct difference after 4 years of ASA intake, suggesting a cumulative effect and a potential protective association between regular ASA intake and PCa development. As for clinical practice, lowering PSA cutoff values by 0.4 ng/ml could be considered in long-term ASA users to avoid a potential bias towards delayed PCa detection.

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Acknowledgements

Prof. Lukas Bubendorf, Department of Pathology, University Hospital of Basel, Switzerland for pathology specimen review. Prof. emeritus Burkhart Seifert, Dept. of Epidemiology for assistance in statistical analysis. Financial support ERSPC Switzerland: The Horten Foundation, Aargau Cancer League, Swiss Cancer League (Grant Nr KFS 787-2-1999 and 01112-02-2001), Health Department of Canton Aargau, Prostate Cancer Research Foundation, Baugarten Foundation and the Messerli Foundation.

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Author notes

  1. Lukas Werner Prause, Lukas Manka, Maciej Kwiatkowski and Daniel Eberli contributed equally to the manuscript

Authors and Affiliations

  1. Department of Urology, University Hospital Zurich, Zurich, Switzerland

    Lukas Werner Prause, Christopher Millan, Elena Lang, Tullio Sulser & Daniel Eberli

  2. Department of Urology, Cantonal Hospital Aarau, Aarau, Switzerland

    Lukas Werner Prause, Stephen F. Wyler, Franz Recker & Maciej Kwiatkowski

  3. Department of Urology, Academic Hospital Braunschweig, Braunschweig, Germany

    Lukas Manka & Maciej Kwiatkowski

  4. Institute of Pathology, Cantonal Hospital Aarau, Aarau, Switzerland

    Rainer Grobholz

  5. Department of Laboratory Medicine, Cantonal Hospital Aarau, Aarau, Switzerland

    Angelika Hammerer-Lercher

  6. Faculty Member, University of Basel, Basel, Switzerland

    Stephen F. Wyler & Maciej Kwiatkowski

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  1. Lukas Werner Prause
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Contributions

LWP, LM and EL: study design, data analysis, manuscript writing. CM, SFW and TS: manuscript editing. RG and AH: data collection. FR, MK and DE: participated in designing the study, study coordination, data collection and supervision. All authors have critically reviewed the manuscript and have approved the final version submitted for publication.

Corresponding authors

Correspondence to Lukas Werner Prause or Lukas Manka.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee (Quality control of data collection for the ERSPC Switzerland (Aarau) was conducted under supervision within the ERSPC. The study protocol of the Swiss arm of the ERSPC was approved by the local ethical committee) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Prause, L.W., Manka, L., Millan, C. et al. Influence of regular aspirin intake on PSA values, prostate cancer incidence and overall survival in a prospective screening trial (ERSPC Aarau). World J Urol 38, 2485–2491 (2020). https://doi.org/10.1007/s00345-019-03054-5

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  • DOI: https://doi.org/10.1007/s00345-019-03054-5

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