Blood cholesterol, tumor clinical characteristics and risk of prostate cancer progression after radical prostatectomy

BACKGROUND: The effects of blood cholesterol levels on prostate cancer prognosis are unclear. We explored the associations between blood cholesterol levels and prostate cancer clinical characteristics including Gleason score and TNM-stage, as well as risk of prostate cancer recurrence and death after radical prostatectomy. The association between statin-induced cholesterol decline and prostate cancer prognosis was also studied. METHODS: The study cohort consisted of 1,314 prostate cancer patients who underwent radical prostatectomy as primary management at the Tampere University Hospital between 1995 and 2009. The follow-up continued until the end of 2016. RESULTS: No associations between cholesterol and prostate cancer severity were found. HDL over 1 mmol/l and LDL over 3 mmol/l were associated with reduced risk of all-cause death in time-dependent analysis. However, the risk association was short-term as neither HDL or LDL measured three years earlier had an effect on prostate cancer prognosis. Modest statin-induced cholesterol decline lowered the risk of prostate cancer recurrence. HRs by modest total cholesterol and LDL declines were 0.24 (0.09-0.60) and 0.31 (0.11-0.88) respectively. CONCLUSIONS: Our findings do not support cholesterol as a risk factor for prostate cancer severity or prognosis after prostatectomy. Cholesterol decline by statin treatment was associated with improved recurrence-free survival compared to statin users whose cholesterol did not decline, which supports importance of controlling for compliance to statin use when estimating effects of statins in prostate cancer