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

OBJECTIVE: The effects of blood cholesterol levels on prostate cancer (PCa) prognosis are unclear. This study explored the associations between blood cholesterol levels and PCa clinical characteristics, including Gleason score and tumor, node, metastasis stage, as well as risk of PCa recurrence and death after radical prostatectomy. The association between statin-induced cholesterol decline and PCa prognosis was also studied.

MATERIALS AND METHODS: The study cohort consisted of 1314 PCa 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 PCa severity were found. High-density lipoprotein (HDL) > 1 mmol/l and low-density lipoprotein (LDL) > 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 3 years earlier had an effect on PCa prognosis. Modest statin-induced cholesterol decline lowered the risk of PCa recurrence. Hazard ratios (95% confidence intervals) by modest total cholesterol and LDL declines were 0.24 (0.09-0.60) and 0.31 (0.11-0.88), respectively.

CONCLUSIONS: The findings do not support cholesterol as a risk factor for PCa 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 the importance of controlling for compliance with statin use when estimating the effects of statins in PCa.