Statin Use and Survival Among Men Receiving Androgen-Ablative Therapies for Advanced Prostate Cancer: A Systematic Review and Meta-analysis.

Concurrent statin use was associated with a 27% reduction in the risk of overall mortality among men receiving androgen-ablative therapies for advanced prostate cancer.

• Pooled HR of 0.73 (95% CI, 0.66-0.82) for overall mortality
• Substantial heterogeneity was present (I2 = 83%)
• Analysis included 25 cohorts of 119,878 men with more than 74,416 deaths
• 65,488 statin users (55% of total population) were included
• Confidence in the evidence was rated low using the GRADE approach

Concurrent statin use was associated with a 35% reduction in the risk of prostate cancer-specific mortality (PCSM).

• Pooled HR of 0.65 (95% CI, 0.58-0.73) for PCSM
• Substantial heterogeneity was present (I2 = 74%)
• Summary estimates pooled multivariable HRs using the generic inverse variance method with random-effects modeling
• Confidence in the evidence was rated low using the GRADE approach

The PCSM benefit associated with statin use was significantly greater for men receiving androgen receptor axis-targeted therapies (ARATs) compared with androgen deprivation therapy (ADT) alone.

• HR for PCSM with ARATs: 0.40 (95% CI, 0.30-0.55)
• HR for PCSM with ADT alone: 0.68 (95% CI, 0.60-0.76)
• P = .002 for difference between subgroups
• This difference was identified through a priori specified subgroup analyses

The systematic review and meta-analysis included 25 cohorts from observational studies reporting associations of concurrent statin use and survival outcomes.

• Sources searched included MEDLINE, EMBASE, Epub Ahead of Print, Cochrane Clinical Trials, Cochrane Systematic Reviews, and Web of Science from inception to September 6, 2022
• Only studies reporting associations in hazard ratios (HRs) were included
• Two authors independently abstracted all data
• Heterogeneity, study quality, and publication bias were evaluated
• A priori specified subgroup and sensitivity analyses were undertaken

The findings are limited by the observational nature of the included data and residual unexplained interstudy heterogeneity.

• Confidence in the evidence was rated low for both overall mortality and PCSM outcomes
• Substantial heterogeneity was present in both overall mortality (I2 = 83%) and PCSM (I2 = 74%) estimates
• The authors concluded that randomized clinical trials are warranted to validate these results