The impact of androgen-deprivation therapy (ADT) on the risk of cardiovascular (CV) events in patients with non-metastatic prostate cancer: a population-based study.

Abstract

OBJECTIVE:

To examine and quantify the contemporary association between androgen-deprivation therapy (ADT) and three separate endpoints: coronary artery disease (CAD), acute myocardial infarction (AMI), and sudden cardiac death (SCD), in a large USA contemporary cohort of patients with prostate cancer.

PATIENTS AND METHODS:

In all, 140 474 patients diagnosed with non-metastatic prostate cancer between 1995 and 2009 within the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database were abstracted. Patients treated with ADT and those not receiving ADT were matched using propensity score methodology. The 10-year CAD, AMI, and SCD rates were estimated. Competing-risks regression analyses tested the association between the type of ADT (GnRH agonists vs bilateral orchidectomy) and CAD, AMI, and SCD, after adjusting for the risk of dying during follow-up.

RESULTS:

Overall, the 10-year rates of CAD, AMI, and SCD were 25.9%, 15.6%, and 15.8%, respectively. After stratification according to ADT status (ADT-naïve vs GnRH agonists vs bilateral orchidectomy), the CAD rates were 25.1% vs 26.9% vs 23.2%, the AMI rates were 14.8% vs 16.6% vs 14.8%, and the SCD rates were 14.2% vs 17.7% vs 16.4%, respectively. In competing-risks multivariable regression analyses, the administration of GnRH agonists (all P < 0.001), but not bilateral orchidectomy (all P ≥ 0.7), was associated with higher risk of CAD, AMI, and SCD.

CONCLUSIONS:

The administration of GnRH agonists, but not orchidectomy, is still associated with a significantly increased risk of CAD, AMI, and, especially, SCD in patients with non-metastatic prostate cancer. Alternative forms of ADT should be considered in patients at higher risk of CV events.

• Authors: Giorgio Gandaglia, Maxine Sun, Ioana Popa, Jonas Schiffmann, Firas Abdollah, Quoc-Dien Trinh, Fred Saad, Markus Graefen, Alberto Briganti, Francesco Montorsi, Pierre I Karakiewicz
• Journal: BJU international (BJU Int) Vol. 114 Issue 6b Pg. E82-E89 (Dec 2014) ISSN: 1464-410X [Electronic] England
• PMID: 24612110 (Publication Type: Journal Article)
• Copyright: © 2014 The Authors. BJU International © 2014 BJU International.

Chemical References

• Androgen Antagonists
• Gonadotropin-Releasing Hormone

Topics

• Aged
• Androgen Antagonists (adverse effects, therapeutic use)
• Cohort Studies
• Coronary Disease (epidemiology)
• Death, Sudden, Cardiac (epidemiology)
• Gonadotropin-Releasing Hormone (agonists)
• Humans
• Male
• Myocardial Infarction (epidemiology)
• Orchiectomy
• Propensity Score
• Prostatic Neoplasms (drug therapy, pathology, surgery)
• Risk Factors
• SEER Program
• United States