BERKELEY, CA (UroToday.com) - Since the first report on the effect of castration on serum phosphatases in prostate cancer,[1] androgen deprivation therapy (ADT) has gained much interest in the management in prostate cancer across different stages. However, ADT is associated with many side effects including general malaise, fatigue, loss in libido, and vasomotor flushing, and may also lead to the occurrence of more serious adverse events including diabetes mellitus, osteoporotic fracture, stroke, and acute myocardial infarction (AMI). While the majority of the literature was based on Caucasians, we investigated the risk of AMI after ADT for prostate cancer in the Chinese population.
In our study, all Chinese prostate cancer patients who were treated primarily with radical prostatectomy or radiotherapy, with (ADT group), or without further ADT (non-ADT group), and from year 2000 to 2009 were reviewed. The ADT group had increased risk of AMI when compared to the non-ADT group (P = 0.004) upon Kaplan-Meier analysis. Upon multivariate Cox regression analyses, poor ECOG performance status, hyperlipidemia, and the use of ADT were shown to be significant risk factors of AMI. We concluded that the use of ADT was associated with increased risk of AMI, and such risk should be carefully considered, especially in men with poor performance status and history of hyperlipidemia.
Although the use of ADT has become the mainstay of treatment in metastatic prostate cancer, there is no conclusive evidence on whether it can prolong survival in this group of patients. The occurrence of major adverse events such as AMI is detrimental and may potentially outweigh the benefit of using ADT. Further prospective studies will be needed to address these concerns. Until then, can we adequately balance the benefits and risks of ADT, and hopefully the treatment strategy can be decided in an individualized approach.
Reference:
- Huggins C, Hodges CV. Studies on prostatic cancer. I. The effect of castration, of estrogen and of androgen injection on serum phosphatases in metastatic carcinoma of the prostate. 1941. J Urol. 2002;167(2 Pt 2):948-51; discussion 52.
Written by:
Jeremy Y.C. Teoh, MBBS, MRCSEd and Anthony C.F. Ng, FRCSEd (Urol), FHKAM (Surgery) as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.
Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong.