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. 2016 Aug 17:16:643.
doi: 10.1186/s12885-016-2691-5.

Cholesterol and prostate cancer risk: a long-term prospective cohort study

Trond Heir  1 , Ragnhild Sørum Falk  2 , Trude Eid Robsahm  3 , Leiv Sandvik  2 , Jan Erikssen  4 , Steinar Tretli  3
Affiliations

Cholesterol and prostate cancer risk: a long-term prospective cohort study

Trond Heir et al. BMC Cancer. .

Abstract

Background: Few studies have taken risk of competing events into account when examining the relationship between cholesterol and prostate cancer incidence, and few studies have a follow-up over several decades. We aimed to use these approaches to examine the relationship between cholesterol and prostate cancer.

Methods: A cohort of 1997 healthy Norwegian men aged 40-59 years in 1972-75 was followed throughout 2012. Cancer data were extracted from the Cancer Registry of Norway. The association between cholesterol and prostate cancer incidence was assessed using competing risk regression analysis, with adjustment for potential confounders. Date and cause of death was obtained from the Cause of Death Registry of Norway.

Results: The study cohort had a cancer risk similar to the general Norwegian population. Prostate cancer was registered in 213 men (11 %), including 62 (3 %) with advanced stage at diagnosis. For overall and advanced stage prostate cancer, the incidence was twice as high in the lowest quartile of cholesterol compared to the highest quartile. These associations remained significant after adjustment for age, smoking, physical fitness, BMI, and systolic blood pressure. Furthermore, high physical fitness and low BMI were associated with increased prostate cancer incidence. Sensitivity analyses excluding events during the first 20 years of observation revealed similar results.

Conclusion: Low cholesterol, as well as high physical fitness and low BMI, may be associated with increased risk of prostate cancer. These findings conflict with current prostate cancer prevention recommendations.

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Figures

Fig. 1
Fig. 1
Flowchart of the cohort of initially healthy 40 to 59 year old men recruited in the period 1972–75 and followed for 40 years, Oslo Ischemia Study
Fig. 2
Fig. 2
Cumulative incidence of prostate cancer by quartiles of cholesterol in a cohort of initially healthy middle-aged men followed for 40 years, n = 1997. The number of prostate cancer diagnosis in each quartile of cholesterol was 80 (quartile 1), 51 (quartile 2), 48 (quartile 3) and 34 (quartile 4). P-value achieved from the Pepe and Mori test comparing the cumulative incidence of cholesterol quartile 1 versus quartile 4
Fig. 3
Fig. 3
Cumulative incidence of prostate cancer by quartiles of cholesterol restricted to men with 20 years or more follow-up time, n = 1520. The number of prostate cancer diagnosis in each quartile of cholesterol was 60 (quartile 1), 42 (quartile 2), 36 (quartile 3) and 21 (quartile 4). P-value achieved from the Pepe and Mori test comparing the cumulative incidence of cholesterol quartile 1 versus quartile 4
Fig. 4
Fig. 4
Cumulative incidence of a localized and b advanced stage prostate cancer by quartiles of cholesterol. The number of localized prostate cancer cases in quartiles of cholesterol was 48, 33, 33, 23, respectively, and the number of advanced prostate cancer cases was 24, 14, 15, 9, accordingly. P-values achieved from the Pepe and Mori test comparing the cumulative incidence of cholesterol quartile 1 versus quartile 4. Fully adjusted Fine and Gray competing risk model is presented in Additional file 1: Table S2A
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