Originally published 5/11/2020
Here’s an optimistic update by a multicenter team of researchers from Harvard Medical School, Harvard School of Public Health, and Ohio State University School of Medicine. Their 2022 paper[i] not only underscores our blog below on aspirin’s protective effect against prostate cancer (PCa), it also offers a possible biological explanation for this phenomenon: aspirin may promote blood vessel health in a way that discourages carcinogenesis, or the formation of cancer. In their study of 572 men, “Current aspirin users had larger vessel area (14.5%) and diameter (6.5%), and lower vessel irregularity (- 8.1%) compared to non-users, indicating a less angiogenic profile.” In other words, larger blood vessels with regular-shaped circular walls may be evidence of less PCa likelihood. This hearkens back to a blog we posted in 2014, in which we describe how exercise such as vigorous walking promotes larger, circular shaped blood vessels, leading to less PCa among men who exercise vigorously. It also ties in with a 2013 paper exploring the association between vascular characteristics and PCa.[ii] Of course, we are not saying that popping aspirin gets you off the exercise hook. In fact, we have numerous blogs encouraging our readers to avoid the temptation to fall into couch potato habits. Our consistent message is, if you want to reduce your chance for PCa, get up and get moving! However, if your circumstances are such that aerobic exercise is not meant to be at this time, could balanced aspirin use at a dosage correct for you can help prevent prostate carcinogenesis? Talk to your doctor before changing ANY health habits.
When was the main ingredient in aspirin first used as medicine?
a) As far back as 3000 B.C.
b) Around 400 B.C.
c) In the mid-18th century
d) Right before the 20th century
e) All of the above
If you chose answer (d), you are correct. What we now call aspirin has a long medical track record. Its active ingredient is a type of chemical called a salicylate. Salicylates are naturally found in some plants and foods, and as far back as ancient times, willow tea or chewing on willow bark were used by healers to bring fevers down or ease the pain of childbirth. By the mid-1700s willow bark extract was widely known for treating pain, fever and inflammation[iii]. Today, it is a cheap, universally available pill that benefits a wide range of conditions.
Preventing colorectal cancer
Everyone knows that if you have a headache or your temperature rises due to the flu or other infection, popping one or two aspirin is like sending in the cavalry to rescue you from uncomfortable symptoms. What most people are not aware of, however, is the merits of this humble drug in cancer prevention. My own interest, of course, is the value of aspirin in lowering the risk of prostate cancer (PCa) but I was very happy to find a May, 2020 published article by Bosetti, et al. regarding prevention of colorectal cancer due to aspirin use.[iv]
The authors, who first wrote about aspirin and cancer risk in 2011, have now updated their data since then through mid-March, 2019. Their 2020 paper, “Aspirin and the risk of colorectal and other digestive tract cancers,” presents an analysis of over 100 studies that included over 156,000 cases. The majority of them were on colorectal cancer (66 studies), but in addition to the risk reduction associated with aspirin use for that cancer, the authors also found reduced chances for squamous-cell esophageal cancer (13 studies), adenocarcinoma of the esophagus and gastric cardia (10 studies), stomach cancer (14 studies), hepato-biliary tract cancer (5 studies), and pancreatic cancer (15 studies). It is important to note that for purposes of this analysis, the authors correlated aspirin dose, frequency and duration of use with the greatest risk reduction.
Findings
What they found was that with daily aspirin use, the longer the duration, the more favorable the result for the abovementioned cancers. They found that 10 years’ duration of aspirin reduced risk by 30%, and about a 35-40% lower risk of esophageal and stomach cancers. Specifically for colorectal cancer, the greater the dose, the better the effect. They concluded that “… the present meta-analysis provides further evidence and quantification of a favourable effect of aspirin on colorectal and other digestive tract neoplasms,” and stated the need for further research to confirm their findings.
Aspirin and prostate cancer
In 2014, members of the same team of authors conducted a similar review of published literature on aspirin and its connection with prostate cancer risk.[v] Their analysis supported previous published studies that showed a “modest favorable effect of aspirin on prostate cancer” and “a nonsignificant reduced risk of death from prostate cancer after a latent period of five or more years.”
During the same year, Dell’Atti, et al. published a study that I have previously blogged about. The authors conducted a pathology analysis of the surgically removed prostates of 385 prostatectomy patients over a 5-years period, divided into two groups:
A. 174 men who had taken 100mg of aspirin daily for 2 or more years
B. 211 men who had not, or only occasionally.
Group A had fewer positive surgical margins, fewer positive lymph nodes, and lower rates of biochemical recurrence within 5 years. This suggests that aspirin has a chemopreventive ability, and the authors concluded that prostate cancer patients who used aspirin daily were “significantly associated with a lower risk of disease progression…”
Picking up from that idea, I also blogged about two studies which offer evidence that “aspirin provides a mechanism whereby the potential for prostate cancer recurrence after treatment by either radiation or prostatectomy is significantly lowered.” Most recently, I wrote on a study that found men diagnosed with high-risk prostate cancer who also used daily aspirin after diagnosis had a lower mortality rate than those who did not. For this blog, I quoted a possible biochemical explanation for aspirin’s effect on high-risk disease, so I hope you’ll take time to read it if you haven’t already seen it.
Aspirin is not just a pain pill or fever reducer. As a blood-thinner, it also saves lives for cardiac patients at risk for heart attacks or those at risk for clot-induced strokes. We now see that it may be a lifesaver for many PCa patients by lowering risk, reducing the chance of recurrence after treatment, and helping those with aggressive disease live longer lives. In its own humble way, aspirin helps create miracles.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
[i] Fu BC, Wang K, Mucci LA, Clinton SK, Giovannucci EL. Aspirin use and prostate tumor angiogenesis. Cancer Causes Control. 2022 Jan;33(1):149-151.
[ii] Tadayyon F, Mellat M, Alizadeh F, Hadi M et al. Prostate cancer: Relationship between vascular diameter, shape and density and Gleason score in needle biopsy specimens. Adv Biomed Res. 2013 Mar 6;2:3.
[iii] Goldberg DR. “Aspirin: Turn of the Century Miracle Drug”. Chemical Heritage Magazine. 2009. Summer;(2):26–30.
[iv] Bosetti C, Santucci C, Gallus S, Martinetti M, La Vecchia C. Aspirin and the risk of colorectal and other digestive tract cancers: an updated meta-analysis through 2019. Ann Oncol. 2020 May;31(5):558-568.
[v] Bosetti C, Rosato V, Gallus S, La Vecchia C. Aspirin and prostate cancer prevention. Recent Results Cancer Res. 2014;202:93-100.
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
