Take a daily Aspirin?

www.practiceupdate.com/C/52353/56


The Physicians’ Health Study randomized over 22,000 healthy men to aspirin, beta-carotene, both, or placebo from 1981 to 1982. Outcomes were subsequently tracked using annual questionnaires. Interestingly, the risk of lethal prostate cancer (metastatic prostate cancer or prostate cancer death) was decreased among current aspirin users (HR, 0.68) and past aspirin users (HR, 0.54). Use of aspirin after diagnosis was similarly associated with decreased risk of lethal prostate cancer (HR, 0.68).

The authors conclude that regular aspirin use — previously, currently, or even after diagnosis — appears to be associated with a lower risk of lethal prostate cancer. Based on these findings, they suggest that a randomized trial is warranted.
– Jeffrey Tosoian, MD, MPH

I've been taking a daily aspirin ever since the results of the study were published (mid 1990s as I recall). I still got prostate cancer :-( That said, I haven't had a heart attack.

...Jerry

PS: I also recall that there were studies indicating that enteric coated aspirin is less effective (for heart attack prevention) than uncoated aspirin.

Jerry_Delaware said...
I've been taking a daily aspirin ever since the results of the study were published (mid 1990s as I recall). I still got prostate cancer :-( That said, I haven't had a heart attack.

...Jerry

PS: I also recall that there were studies indicating that enteric coated aspirin is less effective (for heart attack prevention) than uncoated aspirin.

I have been taking it for heart issues as well, which as nkinney mentioned is more concerning than PC for most.

The study specically addressed "lethal" PC though. Which I thought was interesting.

Re enteric coated, there's where a balancing act comes in, weighing benefits vs risk of ulcers or gastro bleed

Having had mitral valve repair and a bout of endocarditis, my cardiologist had me on 81mg after my surgery and bumped it up to 162mg after endocarditis years later.

InTheShop said...

which means I'll be stopped dead one day by a massive heart attack.

prolly

"Has anyone else wondered why the low dose amount is precisely 81 mg?"

One quarter of full strength aspirin which is 325 mg. Someone else can answer the question, "Why is full strength 325 mg?"

...Jerry

Just thought I'd stick my head in for a sec to provide some balance. The study you're quoting was for aspirin given to men in 1981-2 - before PSA testing of any kind. The authors do state:

"Associations between aspirin and reduced lethality did not hold among cases diagnosed in the PSA era (Table 5, Table 6). Aspirin was not associated with total, high-grade, or advanced PC (Supplementary Table 1), but was associated with lower PC mortality (Supplementary Table 2)... "Associations between current postdiagnostic aspirin and improved survival did not hold for cases diagnosed in the PSA era (Table 3). Results were similar when PC mortality was the outcome (Supplementary Table 2)."

www.europeanurology.com/article/S0302-2838(17)30069-6/fulltext

There was a small RCT reported last year that found "Our data do not show that aspirin or levofloxacin help to decrease the incidence of prostate cancer occurrence, delay castration-resistant prostate cancer transformation, or reduce tumour-associated death."
www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)32012-8/abstract

Associational studies, mostly cohort studies, have been equivocal. Here are a few of the "no effect" studies (there are others that suggest an effect.

"There was no association between aspirin use after a prostate cancer diagnosis and lethal disease in this cohort of prostate cancer survivors."
/www.ncbi.nlm.nih.gov/pmc/articles/PMC3526345/

"Compared with no aspirin use, neither prediagnosis nor postdiagnosis daily aspirin use were statistically significantly associated with PCSM (prediagnosis use, multivariable-adjusted hazard ratio (HR) = 0.92, 95% CI 0.72 to 1.17, postdiagnosis use, HR = 0.98; 95% CI, 0.74 to 1.29). However, among men diagnosed with high-risk cancers (≥ T3 and/or Gleason score ≥ 8), postdiagnosis daily aspirin use was associated with lower PCSM (HR = 0.60; 95% CI, 0.37 to 0.97), with no clear difference by dose (low-dose, typically 81 mg per day, HR = 0.50; 95% CI, 0.27 to 0.92, higher dose, HR = 0.73; 95% CI, 0.40 to 1.34)."
ascopubs.org/doi/abs/10.1200/JCO.2013.54.8875

"We found no evidence of an association between low-dose aspirin use before or after diagnosis and risk of prostate cancer-specific mortality, after potential confounders were accounted for, in UK prostate cancer patients."
/link.springer.com/article/10.1007%2Fs10552-013-0306-x

"Overall, after adjustment for age, gender (where applicable), education status and place of residence, we saw significant associations between aspirin use and tumour extent (P<0.0001) in colorectal and lung cancers but not in prostate and breast cancers (P>0.05)...Association with nodal involvement (N) for all cancers was nonsignificant. Adjusted association of aspirin use with fewer metastases (M) was significant for colorectal and lung cancers (OR ∼0.8, 95% CI 0.7–0.9) and for breast cancer (OR ∼0.6, 95% CI 0.5–0.9) but not for prostate cancer (OR ∼0.9, 95% CI 0.8–1.0)."
/www.ncbi.nlm.nih.gov/pmc/articles/PMC3790151/

"Unlike other NSAIDs, aspirin use whether by prescription or over-the-counter was not associated with prostate cancer risk."
/www.ncbi.nlm.nih.gov/pmc/articles/PMC4183838/

This one showed a deleterious association: "A higher proportion of ASA [aspirin] users (63.5%) and other NSAID users (61.2%) had PC compared with nonusers (41.9%; P <.001). CSPC was more common among ASA users (34.9%; P <.001) compared with other NSAID users (20.0%) and nonusers (20.9%). In multivariate regression analyses, ASA use (odds ratio [OR] = 2.04; 95% confidence interval [CI] = 1.32-3.13; P = .001) and other NSAID use (OR = 2.42; 95% CI = 1.36-431; P = .003) were associated with higher odds of PC detection, whereas ASA use was associated with higher odds of CSPC (OR = 1.62; 95% CI = 1.00-2.62; P = .048)."
www.goldjournal.net/article/S0090-4295(14)00801-2/fulltext

"We found no protective effect of aspirin, statins or antidiabetics in terms of risk for any PCa or high-grade PCa. Use of any statins was associated with an elevated risk of being diagnosed with high-grade prostate cancer."
www.ejcancer.com/article/S0959-8049(15)00124-0/fulltext

"The post-diagnostic use of aspirin is not associated with a decreased risk of prostate cancer outcomes. Increased risks were restricted to patients initiating these drugs after their diagnosis, suggesting a noncausal association."
www.jurology.com/article/S0022-5347(14)04863-0/fulltext

There's a big RCT in the UK that will one day resolve the issue:
/clinicaltrials.gov/ct2/show/NCT02804815

Aspirin certainly has well-known anti-inflammatory effects, and a large body of evidence indicates that aspirin specifically has anti-cancer effects.

The >30 years of "epidemiological monitoring" for this report you linked to, Pratoman, was really quite striking. It went through multiple steps to get to the recent endpoint conclusions/reporting. Here's how the study was carried out.

In 1981/2 at total of 22,071 healthy, males in the USA were randomized to treatment with

• Aspirin
  
• β-Carotene
  
• Aspirin and β-carotene
  
• A placebo

These patients were then followed for 6 or 7 years until 1988, and after that initial trial was completed.
The participants were then asked to complete annual questions asking about

• Aspirin use
  
• Cancer diagnosis
  
• Cancer outcomes

Here's where the study broke-off from being a randomized trial (RCT): If the patients were diagnosed with prostate cancer, they were followed until 2015 (33 or 34 years of follow-up in total); if they were not diagnosed with prostate cancer, they were eventually dropped from follow-up. Without the continued side-by-side, the recently concluded data (first reported just last year) can only give us is suggestions about possibilities/hypothesis as opposed to actual actionable clinical guidance from an RCT...but the hazard ratio (HR) from the report was pretty significant.

Bottom line: the jury is still out on aspirin and PC because several observational studies that have looked at the association (not causation) between aspirin use and prostate cancer outcomes have produced mixed results. The "Add-Aspirin" study launched 2015 will be the first "gold standard" randomly assigned (double-blind) RCT to address whether taking aspirin can prevent recurrence of prostate cancer and can actually improve mortality rates among men already diagnosed with and treated for prostate cancer. So, hold on...initial results will be reported in 10-years, although due to the slow growth of PC that may not really be long enough. In the mean time, talk to your doctor about taking it for cardiac health...

Post Edited (NKinney) : 11/7/2017 2:11:08 PM (GMT-7)

The FDA is primarily concerned with advertising. The message Gremlin posted came shortly after the FDA denied a request from Bayer to change aspirin's label to reflect an indication for primary prevention. Not all organizations agree with the FDA's stance, however: Aspirin: FDA Says 'No' Others Say 'Yes'

The important thing is to have discussion with your primary care physician about EVERY medication (prescribed or OTC)...and not just start taking aspirin on your own.

The USPSTF recommendations are quite nuanced. For adults aged 50 to 59 years with a ≥10% 10-year CVD risk, USPSTF has a Grade B recommendation, which is why my physician raised the topic of low-dose aspirin with me. The recommendation is:

The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years.

In the next age category (I'm still a couply years away), there is a Grade C recommendation:

The decision to initiate low-dose aspirin use for the primary prevention of CVD and CRC in adults aged 60 to 69 years who have a 10% or greater 10-year CVD risk should be an individual one. Persons who are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years are more likely to benefit. Persons who place a higher value on the potential benefits than the potential harms may choose to initiate low-dose aspirin.

American Heart Association guidelines also recommend using aspirin for primary prevention in patients with an elevated risk for coronary disease (a 10-year risk of cardiovascular events of 6% to 10%) (Class I; Level of Evidence A).

It can be good, but it's not good for everyone.

Choose wisely.

Pratoman said...

Jerry_Delaware said...
I've been taking a daily aspirin ever since the results of the study were published (mid 1990s as I recall). I still got prostate cancer :-( That said, I haven't had a heart attack.

...Jerry

PS: I also recall that there were studies indicating that enteric coated aspirin is less effective (for heart attack prevention) than uncoated aspirin.

I have been taking it for heart issues as well, which as nkinney mentioned is more concerning than PC for most.

The study specically addressed "lethal" PC though. Which I thought was interesting.

Re enteric coated, there's where a balancing act comes in, weighing benefits vs risk of ulcers or gastro bleed

I just got out of the hospital for my second gastro belled in two years. Had to get two units of blood this time. Hemoglobin was less than 7, 15 is normal. I am now off aspirin. Denis

Skypilot56 said...
Been taking a baby aspirin for 20 yrs didn't do me any good for PC but maybe helps with cardiovascular??

I wouldn't be so quick to discount the effects. It could be the reason you are alive today.

I'm doomed...