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Drugs reduce prostate cancer risk, journal reports
By V. UPENDER RAO
Published July 24, 2006
In the March/April issue of the Cancer Journal, researchers from Canada reported that frequent use of nonsteroidal anti-inflammatory drugs, also known as NSAIDs, such as Celebrex, Vioxx and aspirin, reduces the risk of developing prostate cancer. They conducted a nested case control study of men age 65 and older who had received at least one prescription for an NSAID between January 1999 and December 2002. From this group, they identified those who had undergone prostate biopsy. They divided this group into two. Those who had a positive biopsy for cancer (2,025 men) served as cases, and the men with a negative biopsy (2,150) served as controls. The odds ratio for prostate cancer for men who took COX inhibitors such as Celebrex or Vioxx was 0.71 (a risk reduction of 29 percent) and 0.84 for those who took aspirin (a risk reduction of 16 percent.) The beneficial effect started becoming apparent after at least 120 days on these drugs within the two-year study period. Longer exposure to the drugs appeared to be critical to achieving the preventive effect. Most of the men who were on a COX inhibitor had osteoarthritis, and those who were on aspirin had cardiovascular disease. The researchers used various statistical methods and clinical information to exclude a direct cancer protective role for these diseases, rather than the drugs, and found none. Therefore, the drugs themselves appear to be cancer-protecting. This also is consistent with many other studies, both clinical and experimental, that define a scientific mechanism of cancer prevention for the COX inhibitors and aspirin. A detailed review of the NSAID (COX inhibitors and aspirin) cancer preventive mechanisms is beyond the scope of this article. Simply put, NSAIDs inhibit Cyclo-oxygenase (COX-1 and COX-2) pathways. Inhibition of COX-1 can lead to stomach ulcers and bleeding, while COX-2 inhibition is cancer preventive. Celebrex and Vioxx were formulated for selective COX-2 inhibition. These suffered a setback recently, owing to an excess of cardiovascular adverse events reported as side effects. NSAIDs also alter many genes. One such gene is NAG-1 (NSAID-activated gene), whose altered expression may be cancer preventing. This has led to the beginning of the development of a new line of COX inhibitors that have no gastric or cardiovascular side effects, but do have anticancer properties. Another new development in cancer prevention is the NO (Nitric Oxide) donating NSAIDs (known as NO-NSAIDs ) and aspirin (NO-aspirin). In experimental cell culture models, NO-aspirin was a thousand-fold more potent in inhibiting colon cancer cell growth compared to the garden-variety aspirin. It also has growth inhibiting properties against a variety of cancers, including pancreas, colon, breast, lung and tongue, in addition to prostate cancer and cell lines derived from hematological malignancies. It is hoped that the latest generation of selective COX inhibitors will soon become available for clinical use as cancer-preventing agents. But a greater yield can be derived from conquering currently known and alterable causes of cancer such as cigarette smoking, obesity, excess alcohol consumption and high-risk personal behavior. V. Upender Rao, MD, FACP, practices at the Cancer and Blood Disease Center in Lecanto.
[Last modified July 24, 2006, 07:05:29]
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