Background: Studies suggest a decreased risk of high-grade prostate cancer in men with lower circulating total cholesterol and that statins may protect against aggressive disease. Confirmation in additional populations and examination of associations for lipoprotein subfractions are needed.
Methods: We examined prostate cancer risk and serum total and HDL cholesterol in the ATBC Study cohort (n = 29,093). Cox proportional hazards models were used to estimate the relative risk of total (n = 2,041), non-aggressive (n = 829), aggressive (n = 461), advanced (n = 412), and high-grade (n = 231) prostate cancer by categories of total and HDL cholesterol.
Results: After excluding the first 10 years of follow-up, men with higher serum total cholesterol were at increased risk of overall (≥240 vs. <200 mg/dl: HR = 1.22, 95% CI 1.03-1.44, p-trend = 0.01) and advanced (≥240 vs. <200 mg/dl: HR = 1.85, 95% CI 1.13-3.03, p-trend = 0.05) prostate cancer. Higher HDL cholesterol was suggestively associated with a decreased risk of prostate cancer regardless of stage or grade.
Conclusions: In this population of smokers, high serum total cholesterol was associated with higher risk of advanced prostate cancer, and high HDL cholesterol suggestively reduced the risk of prostate cancer overall. These results support previous studies and, indirectly, support the hypothesis that statins may reduce the risk of advanced prostate cancer by lowering cholesterol.