Do aspirin and other NSAIDs confer a survival benefit in men diagnosed with prostate cancer? A pooled analysis of NIH-AARP and PLCO cohorts

<span style="margin: 0px; font-family: 'New times rome',serif;">Prostate cancer is one of the leading causes of cancer death in US men. There is an unmet need to identify modifiable risk factors for prostate cancer survival. Experimental studies have suggested that nonsteroidal anti-inflammatory drugs (NSAIDs) may improve prostate cancer survival through anti-thrombotic and anti-inflammation mechanisms. Results from previous observational studies have been equivocal, and few have assessed whether an etiologically relevant time window of exposure exists. We sampled prostate cancer cases from two large US prospective cohorts-NIH-AARP Diet and Health Study and PLCO Cancer Screening Trial-to investigate whether pre- and post-diagnostic aspirin and non-aspirin NSAID use were associated with prostate cancer-specific and all-cause mortality. Cox proportional hazards regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs). Study-specific results were meta-analyzed using fixed-effects models. Pre- and post-diagnostic aspirin or non-aspirin NSAID use were not statistically significantly associated with prostate cancer-specific mortality. However, occasional (less than daily) and daily aspirin users five years or more before prostate cancer diagnosis had 18% (HR=0.82; 95%CI=0.75 to 0.90) and 15% (HR=0.85; 95%CI=0.77 to 0.94) reduced all-cause mortality versus nonusers. Similarly, post-diagnostic occasional and daily aspirin use were associated with 17% (HR=0.83; 95%CI=0.72 to 0.95) and 25% (HR=0.75; 95%CI=0.66 to 0.86) reduced all-cause mortality, independent of pre-diagnostic aspirin use. This study suggests that aspirin or non-aspirin NSAIDs are not associated with prostate cancer survival. However, aspirin use both before and after prostate cancer diagnosis was associated with longer overall survival, highlighting the importance of comorbidity prevention among prostate cancer survivors. </span>

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