Objectives

To analyze the influence of aspirin (ASA) intake on PSA values and prostate cancer (PCa) development in a prospective screening study cohort.

Methods

4314 men from the Swiss section of the European Randomized Study of Screening for Prostate Cancer (ERSPC) were included. A transrectal prostate biopsy was performed in men with a PSA level ≥ 3 ng/ml. Mortality data were obtained through registry linkages. PCa incidence and grade, total PSA, free-to-total PSA and overall survival were compared between ASA users and non-users.

Results

Median follow-up time was 9.6 years. In 789 men (18.3%) using aspirin [ASA +], the overall PCa incidence was significantly lower (6.8% vs. 9.6%, p = 0.015), but the multivariate Cox regression analysis showed no significant decrease in risk of PCa diagnosis (HR 0.84, p = 0.297). Total PSA values were significantly lower in ASA users for both baseline (1.6 vs. 1.8 ng/ml, p = 0.007) and follow-up visits (1.75 vs. 2.1 ng/ml, p < 0.001). Multivariate Cox regression analysis predicted significantly higher overall mortality risk among ASA users (HR 1.46, p = 0.009).

Conclusions

In our study population, PCa incidence was significantly reduced among patients on aspirin. While we did not observe a statistically significant PCa risk reduction during the follow-up period, we found lower PSA values among ASA users compared to non-users, with a more distinct difference after 4 years of ASA intake, suggesting a cumulative effect and a potential protective association between regular ASA intake and PCa development. As for clinical practice, lowering PSA cutoff values by 0.4 ng/ml could be considered in long-term ASA users to avoid a potential bias towards delayed PCa detection.

中文翻译：

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在一项前瞻性筛查试验（ERSPC Aarau）中，定期服用阿司匹林对PSA值，前列腺癌发生率和总体生存的影响。

目标

在一项前瞻性筛查研究队列中分析阿司匹林（ASA）摄入量对PSA值和前列腺癌（PCa）发育的影响。

方法

纳入了《欧洲前列腺癌筛查随机研究》（ERSPC）瑞士部分的4314名男性。PSA≥3 ng / ml的男性进行经直肠前列腺活检。死亡率数据是通过注册表链接获得的。比较了ASA用户和非用户的PCa发生率和等级，总PSA，免费总PSA和总生存期。

结果

中位随访时间为9。6年。在使用阿司匹林[ASA +]的789名男性中（18.3％），PCa的总体发生率显着降低（6.8％对9.6％，p  = 0.015），但是多因素Cox回归分析显示PCa诊断的风险没有显着降低（ HR 0.84，p  = 0.297）。在基线（1.6 vs. 1.8 ng / ml，p  = 0.007）和随访期间（1.75 vs. 2.1 ng / ml，p  <0.001）的ASA用户中，总PSA值明显较低。多变量Cox回归分析预测ASA用户的总体死亡风险显着更高（HR 1.46，p  = 0.009）。

结论

在我们的研究人群中，使用阿司匹林的患者中PCa的发生率显着降低。尽管我们在随访期间未观察到PCa风险的统计学降低，但我们发现ASA用户中的PSA值低于非用户，而ASA摄入4年后的PSA值差异更明显，这表明了累积效果和定期摄入ASA与PCa发育之间的潜在保护关联。对于临床实践，长期ASA用户可考虑将PSA临界值降低0.4 ng / ml，以避免潜在的偏向于PCa检测延迟。