Postdiagnosis Aspirin Use Associated With Reduced Disease-Specific Mortality Only in High-Risk Subgroup of Men With Nonmetastatic Prostate Cancer


Key Points

  • Postdiagnosis aspirin use was associated with reduced disease-specific mortality among patients with high-risk prostate cancer.
  • There was no obvious difference in benefit according to low or high aspirin dose in this subgroup.

A recent analysis of a large clinical database indicated that postdiagnosis aspirin use was associated with a 57% reduction in prostate cancer–specific mortality among men with nonmetastatic prostate cancer. In a study in a prospective cohort reported in the Journal of Clinical Oncology, Jacobs et al found that postdiagnosis aspirin use was associated with reduced disease-specific mortality only among men with high-risk cancers, with no obvious difference in outcome according to aspirin dose being detected in this subgroup.

Study Details

The study included men diagnosed with nonmetastatic prostate cancer in the Cancer Prevention Study-II Nutrition Cohort between enrollment in 1992 or 1993 and June 2009. Aspirin use was recorded at enrollment, in 1997, and every 2 years thereafter. Through 2010, there were 441 prostate cancer deaths among 8,427 prostate cancer cases with information on prediagnosis aspirin use and 301 deaths among 7,118 cases with information on postdiagnosis aspirin use.

Multivariate analyses of prostate cancer-specific mortality included adjustment for age at diagnosis, race, year of diagnosis, tumor extent (T1–T2 or T3–T4), nodal involvement, Gleason  score (2–6, 7, ≥8, unknown), initial treatment type, use of cholesterol-lowering drugs, cardiovascular disease, and prediagnosis prostate-specific antigen testing not leading to a prostate cancer diagnosis.

No Overall Benefit

Compared with no aspirin use, neither prediagnosis daily aspirin (adjusted hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.72–1.17) nor postdiagnosis daily aspirin use (HR = 0.98, 95% CI = 0.74–1.29) were significantly associated with disease-specific mortality.

Benefit in High-Risk Patients

Among men diagnosed with high-risk cancers, defined as ≥ T3 or Gleason score ≥ 8, postdiagnosis daily aspirin use was associated with significantly reduced disease-specific mortality (HR = 0.60, 95% CI = 0.37–0.97). In this subgroup, there was no clear difference in benefit according to aspirin use at a lower-dose (ie, 81 mg/d; HR = 0.50, 95% CI = 0.27–0.92) or a higher dose (HR = 0.73, 95% CI = 0.40–1.34).

The investigators concluded: “A randomized trial of aspirin among men diagnosed with nonmetastatic prostate cancer was recently funded [UK Add-Aspirin trial]. Our results suggest any additional randomized trials addressing this question should prioritize enrolling men with high-risk cancers and need not use high doses.”

Eric J. Jacobs, PhD, of the American Cancer Society, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by the American Cancer Society. Stephen J. Freedland, MD, reported a consultant or advisory role with Bayer.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.