Nonsteroidal anti-inflammatory drugs and prostate cancer: a systematic review of the literature and meta-analysis.

Prostate cancer is the most common visceral cancer in men. Many studies have shown that nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the risk of prostate cancer. We systematically searched all relevant databases (MEDLINE, EMBASE, The Cochrane Collaboration, CINAHL, Database of Abstracts of Review of Effects and ACP Journal Club) to March 2008. We also explored bibliographies of the articles, pertinent journals and conferences. We selected relevant articles according to predefined inclusion criteria by 2 independent reviewers. We used both fixed and random-effect models for meta-analysis. We performed subgroup and sensitivity analysis based on predefined variables. From 962 extracted articles, 20 met the inclusion criteria with a total of 25 768 participants. All the studies had an observational design. There was a statistically significant protective effect for NSAIDs on risk of prostate cancer (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.86-0.97). Subgroup analysis did not show any effect of study design or quality score on the results. There was a small but statistically significant protective effect for acetylsalicylic acid (ASA) (OR 0.95, 95% CI 0.91-1.00). Exposure to non-ASA NSAIDs was associated with a slightly reduced likelihood of prostate cancer (OR 0.92, 95% CI 0.85-1.00). With the available data, we were not able to determine an optimum dosage for NSAIDs. We conclude that taking NSAIDs may reduce the risk of prostate cancer. Nevertheless, the effect is small.