The authors utilized the robust Prostate Cancer Data Base Sweden to identify 9,856 men diagnosed with prostate cancer between 1992-1999 who either received a GnRHa or bilateral orchiectomy. They were able to assess incident cases of CVD and fatalities associated with CVD through additional national registries. Among providers utilizing the highest proportion of GnRHa, the risk of CVD was lower compared to lower uses of GnRHa (HR 0.81, 95%CI 0.70-0.95) during the first year after diagnosis, although there was no difference after longer follow-up. When comparing the CVD outcomes in the first year between men undergoing GnRHa vs bilateral orchiectomy, patients receiving GnRHa had a lower risk of CVD in the first year (RR 0.84, 95%CI 0.76-0.92), although there was no difference thereafter. Importantly, there was no increased crude probability of CVD for men receiving GnRHa or those undergoing bilateral orchiectomy. The author’s note a possible selection bias and lack of patients on GnRH antagonists as limitations of the study.
In summary, it is encouraging that men in this population-based study undergoing either GnRHa or bilateral orchiectomy castration do not have an increased long-term risk of CVD. For patients undergoing bilateral orchiectomy, this finding may be purely of historical importance given the less frequent use of bilateral orchiectomy as the castration modality of choice in current practice.
Presented by: P. Stattin, Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
Written by: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto
at the #EAU17 -March 24-28, 2017- London, England