Androgen deprivation therapy (ADT) includes bilateral orchiectomy or long-acting Gonadotropin-Releasing Hormone (GnRH) agonists/antagonists. It remains controversial with respect to ADT associated cardiovascular outcomes. Hereby, we compared the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with prostate cancer receiving either surgical castration or GnRH therapies.
Using Taiwan Cancer Registry (TCR) and Taiwan's National Health Insurance Research Database (NHIRD), we identified 8,413 patients receiving GnRH therapies compared with 694 receiving surgical castration from 2008 to 2017. The median follow-up duration was 3 years.
The crude incidences of 3-year mortality and MACCEs were 19.90% vs. 26.51% and 8.23% vs. 8.65% in patients receiving GnRH therapies or surgical castration, respectively. After adjusting for age, cancer stage and comorbidities, despite no significant differences in MACCEs between groups, there was a slight increase in the incidence of acute myocardial infarction (AMI) in patients receiving surgical castration compared with those receiving GnRH therapies. The mortality adjusted hazard ratios of MACCEs and AMI among patients receiving surgical castration were 1.11 and 1.8-fold higher than those receiving GnRH therapies. Notably, in subgroup analysis regarding to cancer stage, patients with cancer stage IV showed the most significantly increasing risk of AMI in those receiving surgical castration compared with GnRH therapies.
Collectively, we indicated an increased risk of AMI in patients with prostate cancer, especially in patients receiving surgical castration rather than those receiving GnRH therapies. Our findings highlight concerns regarding the cardiac safety of surgical castration compared with GnRH therapies.
The Journal of urology. 2021 Dec 02 [Epub ahead of print]
Wei-Chih Kan, Kun-Lin Hsieh, Yi-Chen Chen, Chung Han Ho, Chon-Seng Hong, Chun-Yen Chiang, Nan-Chun Wu, Michael Chen, Jhih-Yuan Shih, Zhih-Cherng Chen, Wei-Ting Chang
Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan., Division of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan., Department of Hospital and Health Care Administration, Chi-Mei Medical Center, Tainan, Taiwan., Division of Cardiology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.