PURPOSE: To test the association between serum lipid levels prior to androgen deprivation therapy (ADT) and risk of CRPC and metastasis.
MATERIALS AND METHODS: We identified 302 men in the SEARCH database who received ADT after radical prostatectomy for non-metastatic disease, never used statins before ADT, and had available serum lipid data within two years prior to ADT. Cox proportional hazards models were used to test associations between total cholesterol (<200 vs. ≥200 mg/dl), low-density lipoprotein (LDL; <130 vs. ≥130 mg/dl), high-density lipoprotein (HDL; ≥40 vs. <40 mg/dl) and triglycerides (<150 vs. ≥150 mg/dl) and risk of CRPC and metastasis after ADT, adjusting for potential confounders. In subanalyses, we restricted to men who remained statin non-users post-ADT.
RESULTS: Median follow-up was 67 months; 42 men developed CRPC and 44 metastasis. Men with elevated cholesterol had earlier ADT year and longer follow-up, and higher rates of statin use post-ADT. In multivariable analysis, total cholesterol and LDL were unrelated to CRPC. Low HDL (<40 vs. ≥40mg/dL) was suggestively linked with increased risk of CRPC (HR 1.86; 95%CI 0.99-3.48), with a stronger association in men who remained statin non-users post-ADT (HR 3.64; 95%CI 1.45-9.17). Results for metastasis were similar to those found for CRPC.
CONCLUSIONS: Among men with non-metastatic prostate cancer starting ADT, serum cholesterol was unrelated to CRPC or metastasis. Low HDL was suggestively associated with increased CRPC and metastasis risk, particularly in statin never-users. Further studies are needed to explore a potential role for lipids in prostate cancer progression after ADT.