AUA 2018: Non-Alcoholic Fatty Liver Disease in Men Undergoing ADT for Prostate Cancer

San Francisco, CA ( Androgen deprivation therapy (ADT) is associated with the development of diabetes and metabolic syndrome. However, its effect on the development of non-alcoholic fatty liver disease (NAFLD), a condition frequently accompanying metabolic syndrome, and other liver conditions have not been investigated.  In this study, the authors analyzed the dose-dependent effect of ADT for localized prostate cancer on the risk of NAFLD, liver cirrhosis, hepatic necrosis, and any liver disease.

A total of 82,938 men aged 66 and older diagnosed with localized prostate cancer (PCa) within the Surveillance, Epidemiology, and End Results-Medicare (SEER) database between 1992 and 2009 were analyzed. For the purpose of this study, men with pre-existing NAFLD, liver disease, diabetes, and metabolic syndrome were excluded. Using competing-risk regression models, we compared the risk of NAFLD between men who received ADT within 6 months of diagnosis versus those who did not. We also explored the influence of cumulative exposure to ADT, calculated as monthly equivalent doses of gonadotropin-releasing hormone (GnRH) agonists or antagonists (11 doses).

Overall, 37.5% of men received ADT within six months of diagnosis. Men treated with ADT were more likely to be diagnosed with NAFLD (hazard ratio [HR] 1.54, 95 % confidence interval [CI] 1.40-1.68), liver cirrhosis (HR 1.35, 95 % CI 1.12 -1.60), liver necrosis (HR 1.41, 95% CI 1.15-1.72) and any liver disease (HR 1.47, 95% CI 1.35-1.60) as shown in Figure 1. A dose-response relationship was observed between the number of doses of ADT, NAFLD and any liver disease.

UroTodau AUA2018 HR for study endpoints

In conclusion, use of ADT in men with PCa has associated in a dose-dependent manner with an elevated risk of NAFLD. Further investigation is needed to elucidate the mechanisms that lead to the development of NAFLD.

Presented by: Philipp Gild, Hamburg, Germany
Co-Authors: Alexander P. Cole, Boston, MA, Nicolas von Landenberg, Herne, Germany, Anna Krasnova, Maxine Sun, Lorelei A. Mucci, Stuart R. Lipsitz, Boston, MA, Felix K.H. Chun, Frankfurt, Germany, Paul L. Nguyen, Shehzad Basaria, Adam S. Kibel, Quoc-Dien Trinh, Boston, MA

Written by:  Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at the 2018 AUA Annual Meeting - May 18 - 21, 2018 – San Francisco, CA USA