Overall effect estimates for prostate cancer and statin use according to study characteristics.

<p>PSA, Prostate specific antigen; BMI, Body mass index; ALS, Adverse life style; RR, Relative risk; CI, Confidence interval; d.f., Degree of freedom.</p>*<p>Relative risk from fixed-effects model due to no heterogeneity among the studies;</p>†<p><i>P</i> value representing significant inverse association between statin use and prostate cancer;</p>‡<p>Statistically significant for homogeneity;</p>§<p>Test of interaction was not statistically significant;</p>∥<p>Statistically significant for no publication bias.</p

Statin use and risk of advanced prostate cancer.

<p>Pooled estimate of relative risk (RR) and 95% confidence intervals (CIs) of advanced prostate cancer (PCa) associated with statin use based on 7 studies (5 cohort and 2 case-control studies) involving 266,209 participants including 5,236 advanced PCa cases. Squares indicate RR in each study. The square size is proportional to the weight of the corresponding study in the meta-analysis; the length of horizontal lines represents the 95% CI. The unshaded diamond indicates the pooled RR and 95% CI (fixed-effects model).</p

Studies evaluating the association between statin use and risk of advanced prostate cancer.

<p>RR, Relative risk; CI, Confidence interval; PCa, Prostate cancer.</p>*<p>Cohort studies;</p>†<p>Case-control studies;</p>‡<p>Definition of advanced prostate cancer was taken from original research articles.</p

Studies included in the meta-analysis.

<p>PCa, Prostate cancer; NR, Not reported.</p>*<p>Publication year;</p>†<p>Country of study conducted;</p>‡<p>Cohort studies;</p>§<p>Case-control studies.</p>∥<p>a, systematic use of lovastatin <i>vs.</i> SEER data; b, any use of statin <i>vs.</i> use of bile acid-binding resins; c, use of statins <i>vs</i>. no use of statins; d, current use of statins <i>vs</i>. no current use of statins; e, any use of statins <i>vs.</i> no use of statins; f, systematic use of statins <i>vs.</i> general population; g, ever use of statins <i>vs.</i> no use of statins; h, use of statins <i>vs</i>. use of anti-hypertensives; i, current use of cholesterol-lowering drugs <i>vs.</i> never use of cholesterol-lowering drugs.</p>¶<p>A, self-reported; B, medical records; C, prescription database.</p>#<p>1, age; 2, race; 3, diabetes mellitus; 4, BMI; 5, NSAID use; 6, education; 7, elevated cholesterol; 8, history of PSA testing; 9, cardiovascular disease; 10, family history of prostate cancer; 11, use of diuretics; 12, use of calcium channel blockers; 13, use of angiotensin-converting enzyme inhibitors; 14, use of angiotensin receptor blockers; 15, use of metformin; 16, use of sulfonylureas; 17, use of insulin; 18, alcohol use; 19, smoking; 20, height; 21, major ancestry; 22, vasectomy; 23, vigorous physical activity; 24, aspirin use; 25, total energy intake; 26, intakes of calcium, fructose, a-linolenic acid, tomato sauce, red meat, fish, supplemental zinc, and high intake of vitamin E; 27, use of other lipid-lowering drugs; 28, use of cardiovascular drugs; 29, use of hormones; 30, prior hospitalisation; 31, chronic disease score; 32, frequency of physician visits; 33, previous neoplasm; 34, use of fibric acids; 35, calendar period of PSA screening; 36, propensity score; 37, cancer; 38, dementia; 39, hypertension; 40, use of 5-α reductase inhibitors; 41, use of α-blockers; 42, follow-up period; 43, study center; 44, interview year; 45, clinical stage and biopsy gleason score; 46, weight; 47, thyroid disease; 48, renal failure; 49, chest pain; 50, mental illness; 51, lung disease; 52, gastro-intestinal disease; 53,number of cores taken; 54, prostate volume; 55, benign prostatic hyperplasia; 56, matching variables.</p

Studies evaluating the association between long-term statin use and risk of total prostate cancer.

<p>RR, Relative risk; CI, Confidence interval; NR, Not reported.</p>*<p>Cohort studies;</p>†<p>Case-control studies;</p>‡<p>Definition of long-term statin use was taken from original research articles.</p

Assessment of publication bias.

<p>Funnel plot (publication bias assessment plot) of the relative risk of developing prostate cancer, by the standard error, for all studies. Circles- studies included in the meta-analysis. Relative risks are displayed on a logarithmic scale. p = 0.56 for the Begg's test, and p = 0.12 for the Egger's test.</p