JAMA Netw Open

Statins linked to longer survival in advanced prostate cancer

August 22, 2025

Study details: This cohort study pooled patient-level data from two phase 3 trials—SPARTAN (NCT01946204) and TITAN (NCT02489318)—evaluating apalutamide in advanced prostate cancer. Patients received androgen deprivation therapy with or without apalutamide. Statin use during treatment was assessed regardless of start or end date. Survival and cardiac risks were analyzed using weighted Cox and Fine and Gray models.

Results: Of 2,187 patients, 1,288 received apalutamide and 900 received placebo. Statin users were older, had higher BMI, and slightly better performance status. In apalutamide-treated patients, statin use was linked to significantly better overall survival (TITAN: hazard ratio [HR], 0.53; SPARTAN: HR, 0.54), with 3-year survival rates 14% higher in TITAN and 8% higher in SPARTAN. No survival benefit was seen in placebo groups (TITAN: HR, 0.65; 95% confidence interval [CI], 0.38-1.13; SPARTAN: HR, 1.16; 95% CI, 0.76-1.77). Statin users had a higher risk of grade ≥3 cardiac adverse events in both apalutamide (HR, 2.62) and placebo (HR, 2.36) arms, which may reflect their preexisting cardiovascular comorbidity.

Clinical impact: Statins may improve survival in patients receiving apalutamide for advanced prostate cancer. However, given the post hoc exploratory nature of this study, authors conclude that the findings are at best hypothesis generating, and need further validation in additional studies.

Source:

Roy S, et al. (2025, August 20). JAMA Netw Open. Statin Use in Patients With Advanced Prostate Cancer in the TITAN and SPARTAN Trials. https://pubmed.ncbi.nlm.nih.gov/40833694/