New research from the US found that men who regularly took common painkillers like aspirin and ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) had lower circulating levels of PSA (prostate-specific antigen), the biomarker that doctors use to assess whether a man is at risk of prostate cancer. However, the researchers were keen to stress that this does not necessarily mean that NSAIDs lower the risk of prostate cancer.

The study was the work of first author Dr Eric A Singer, chief urology resident at the Department of Urology, University of Rochester Medical Center, Rochester, New York, and colleagues, and is published on 8th September in the online issue of Cancer.

Singer and colleagues said men should not start taking NSAIDs on the strength of their findings:

"We showed that men who regularly took certain medications like aspirin and other non-steroidal anti-inflammatory drugs, or NSAIDS, had a lower serum PSA level," said Singer, but he then added that:

"There's not enough data to say that men who took the medications were less likely to get prostate cancer."

He explained that this was a limited study, and they did not find out how many of the men they studied actually went on to get prostate cancer.

For the study, Singer and colleagues looked at data on 1,319 men over 40 who participated in the 2001-2002 National Health and Nutrition Examination Survey (NHANES) conducted by the US Centers for Disease Control and Prevention (CDC).

They looked for links between the men's use of NSAIDs like aspirin and ibuprofen, and another painkiller, acetaminophen (paracetamol) and their PSA levels, and adjusted for the effects of: age, race, educational level, smoking status, body mass index, co-existing inflammations, and heart disease.

They found that regular use of NSAIDs was linked to a 10 per cent lower PSA level compared to non-use. The figures for acetaminophen (paracetamol) were similar but not statistically significant, because of the much smaller proportion of men who took this painkiller compared to the others. Only 1.3 per cent of the men regularly took acetaminophen (paracetamol) compared to 19.8 per cent who regularly took NSAIDs like aspirin and ibuprofen.

Singer and colleagues concluded that their findings:

"Suggest that regular NSAID consumption may reduce serum PSA levels. Whether this is indicative of a protective effect on prostate cancer risk or masks possible prostate injury resulting in reduced detection of prostate cancer is unclear. Given the widespread consumption of NSAIDs and the regular use of PSA for the assessment of prostate cancer risk, the potential implications of the current study's findings may be substantial and warrant further investigation."

While some people might suggest that a lower PSA level directly translates to a lower risk of prostate cancer, Singer and colleagues cautioned against this conclusion. Corresponding co-author, Dr Edwin van Wijngaarden who is assistant professor in the Department of Community and Preventive Medicine at the University of Rochester Medical Center, said:

"While our results are consistent with other research that indicates that certain painkillers may reduce a man's risk of getting prostate cancer, the new findings are preliminary and don't prove a link."

Singer added that PSA can go up for other reasons, not to do with cancer. PSA is also an indicator of inflammation that is often but not always linked to cancer, and reduced PSA could just mean that the inflammation has reduced without affecting cancer risk. It could also be possible that the NSAIDs have lowered the PSA and masked a man's risk of getting prostate cancer, but the real risk is unaltered, said Singer.

"These findings underscore the importance for doctors to know what medications their patients are on," said Singer. He said doctors were aware of medications used to treat an enlarged prostate that can also reduce PSA levels, but they should now also ask patients about their use of NSAIDs.

"The data is very interesting, but it will take more research to determine how to interpret the findings," said Singer, adding that:

In the meantime, this shouldn't change men's behavior or prompt them to take these medications to try to prevent prostate cancer."

"Prostate-specific antigen levels in relation to consumption of nonsteroidal anti-inflammatory drugs and acetaminophen."
Eric A. Singer, Ganesh S. Palapattu, Edwin van Wijngaarden.
Cancer, Published Online: 8 Sep 2008.
DOI: 10.1002/cncr.23806

Click here for Abstract.

Source: Cancer.

: Catharine Paddock, PhD

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