Liver Disease in Men Undergoing Androgen Deprivation Therapy for Prostate Cancer

Androgen deprivation therapy is associated with development of diabetes and metabolic syndrome. Its effect on developing non-alcoholic fatty liver disease, a condition frequently co-occuring with metabolic syndrome, and other subsequent liver conditions (liver cirrhosis, hepatic necrosis, any liver disease) has not been investigated. 
 MATERIALS & METHODS: We identified 82,938 men aged 66 and older diagnosed with localized prostate cancer within the Surveillance, Epidemiology and End Results- Medicare database, 1992-2009. Men with pre-existing non-alcoholic fatty liver disease, liver disease, diabetes, and metabolic syndrome were excluded. Propensity score adjusted Competing-risk regression models compared the risk of non-alcoholic fatty liver disease between men who received androgen deprivation with those who did not. We also explored the influence of cumulative exposure to androgen deprivation therapy, calculated as monthly equivalent doses of gonadotropin-releasing hormone agonists/antagonists (<7, 7- 11, >11 doses).
 RESULTS: Overall, 37.5% of men received androgen deprivation therapy. These were more likely to be diagnosed with non-alcoholic fatty liver disease (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). A dose-response relationship was observed between the number of doses of androgen deprivation therapy, non-alcoholic fatty liver disease and any liver disease.

Androgen deprivation therapy in men with prostate cancer is associated with diagnosis of non-alcoholic fatty liver disease. Usual limitations of observational study design apply, including a possible inaccuracy to define outcomes in a population-based registry.

The Journal of urology. 2018 Apr 16 [Epub ahead of print]

Philipp Gild, Alexander P Cole, Anna Krasnova, Barbra A Dickerman, Nicolas von Landenberg, Maxine Sun, Lorelei A Mucci, Stuart R Lipsitz, Felix K-H Chun, Paul L Nguyen, Adam S Kibel, Toni K Choueiri, Shehzad Basaria, Quoc-Dien Trinh

Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA., Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA., Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany., Department of Medical Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA, USA., Department of Urology, University Hospital Frankfurt, Frankfurt, Germany., Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts, USA., Research Program in Men's Health: Aging and Metabolism, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts., Center for Surgery and Public Health, Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: .

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