Cimetidine Use And The Risk For Prostate Cancer: Results From The VITAL Cohort Study

Previously, it was suggested that men filling greater than 20 cimetidine prescriptions were at increased risk of developing prostate cancer (CaP). Cimetidine, but not other H2 blockers, can inhibit dihydrotestosterone from binding to androgen receptors and increase levels of estradiol. This could decrease the risk of CaP. However, cimetidine can increase levels of prolactin and decrease prostatic zinc levels, which could increase the risk of CaP.

Dr. Velicer and colleagues from the University of Washington evaluated the association between use of cimetidine and other H2 blockers and CaP risk. The researchers used a database of 33,506 men who participated in a prospective cohort study in Washington State. The cohort consisted of men participating in the VITAL (VITamins And Lifestyle) study, ages 50 to 76 and living in Washington State. A 24 page self-administered questionnaire was mailed that included items on medical history, personal characteristics and cancer risk factors. Ever usage, duration of usage and cumulative usage of H2 blockers was included. Baseline data was collected between 2000 and 2002. Follow-up data was collected through 2003 and linked to the SEER cancer registry. A total of 548 incident cases of CaP were identified.

Compared to men who did not use H2 blockers, cimetidine users were more likely to be older, have lower incomes, have benign prostatic hyperplasia and use medications for BPH. In addition, cimetidine users were more likely to smoke or have smoked, and have a greater body mass index. A total of 3.6% of men reported use of cimetidine and 10.9% reported use of other H2 blockers.

Ever use of cimetidine was not associated with CaP risk compared with no use of H2 blockers. Neither number of years of cimetidine use nor cumulative use (1 to 6 days) was associated with CaP risk. However, 10-year daily cimetidine use was associated with an increased risk (RR, 2.35) compared with no H2 blocker use. Use of other H2 blockers, including daily use for 10 years was not associated with CaP risk.

This study is limited by a low response rate of 21%, lack of information on doses of cimetidine and distinguishing between prescription and over the counter cimetidine.

By Christopher P. Evans, M.D.

Ann Epidemiol 2006;epub
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