Prostate cancer affects 1 in 7 American men at some point in their lifetimes. Most men diagnosed with prostate cancer don’t die from it, but anxiety around the disease remains high. Nearly half of men don’t know that most prostate cancer patients survive, according to a survey conducted this month. September is National Prostate Cancer Awareness Month.

Recent controversy about screening has stoked fears. The main form of screening is the prostate specific antigen, or PSA, test. But the test doesn’t actually diagnose cancer; it only flags elevated risk. Because it leads many patients down a path of invasive tests and unnecessary treatments, the U.S. Preventive Services Task Force has recommended against average-risk patients undergoing the screening.  

So where does that leave men who are looking for ways to be proactive?

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Aspirin and Other NSAIDs May Lower Cancer Risk

A growing body of evidence suggests that aspirin reduces the risk of some types of cancer, including prostate cancer. A new meta-analysis found that men who regularly used aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) are 13 percent less likely to develop prostate cancer. The results were presented at the annual American Association for Cancer Research International Conference in New Orleans this week.

“Our data support the hypothesis that anti-inflammatory drugs may have a biological role in arresting prostate cancer development, but this requires formal prospective testing in randomized trials,” lead author Adriana Vidal, an assistant professor of surgery at the Duke University School of Medicine, said in a press statement.

The Duke researchers used data from 6,390 patients in Europe and the United States who had elevated PSA test results but negative prostate biopsies, meaning that they did not have prostate cancer at the time of testing. 

Vidal and her colleagues compared long-term cancer rates among patients who used aspirin, NSAIDs, or both, to rates among patients who used neither. The number-crunching suggested that the medicines reduced total risk by 13 percent. They also lowered the risk of aggressive prostate cancer by 17 percent.

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The possible preventative role of aspirin, and to a lesser extent other NSAIDs, has been considered in the past. By focusing on patients who had biopsies, the Duke researchers resolved one statistical dilemma. NSAIDs may bring PSA levels down on their own, and could therefore lower the rates of cancer detection, rather than the rates of cancer itself. But with the biopsy results, the proof was clear.

It's important to note that the use of NSAIDs alone would not diminish a man’s chances of early detection if he did later develop cancer, the researchers said.

“We found that NSAIDs only lower PSA by a small amount, and we predict this would have no effect on PSA's ability to predict prostate cancer in these men,” said Vidal. 

Risks were consistent for the European and American patients, marking an advance over previous studies on NSAIDs that had reached different conclusions on opposite sides of the Atlantic.

New Recommendations Don't Offer Straightforward Advice

For men who are already taking a low dose of aspirin to reduce their risk of heart disease, the new findings are reassuring. But how about for the others?

“Men should discuss with their doctors the benefits and risks of taking these medicines to potentially lower prostate cancer risk,” Vidal said.

Elizabeth Platz, Sc.D., a cancer prevention expert at the Johns Hopkins Bloomberg School of Public Health, said that while the Duke research strengthens and clarifies the evidence that NSAIDs are linked to cancer risk, they don’t yet translate into a simple piece of advice for men to follow.

Even when it comes to something as common as aspirin, there’s no across-the-board recommendation. That’s because even aspirin carries health risks — notably, gastrointestinal bleeding. A review of the literature showed that because of the relatively small benefit NSAIDs provide, the risk of stomach bleeding was high enough that doctors shouldn’t advise male patients to take aspirin for cancer prevention alone.

Instead, when doctors discuss the complicated balance of risks and benefits involved in PSA screening with their patients, they can also talk about NSAIDs.

“It’s hard for the public because they want to know the answer, they want to know what should they do, but this is science and there’s a process that we go through and it is complicated,” Platz said.

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