Association of Androgen Deprivation Therapy with Metabolic Disease in Prostate Cancer Patients: An Updated Meta-Analysis
Methods: We searched PubMed, Web of Science, and Scopus in May of 2022 for studies investigating the risk of metabolic syndrome (MetS), diabetes, and hypertension from ADT in PC patients using keywords. Only full-length studies with a control group of PC patients not on ADT were included. All results compatible with each outcome domain in each included study were sought. For included studies, relative risk (RR) was pooled using a random effects model and a trim-fill approach was used to adjust for publication bias.
Results: 1,846 records were screened, of which 19 were found suitable for data extraction. Five studies, including 891 patients, were evaluated for MetS as an outcome, with the random effects model showing a pooled RR of 1.60 ([95% Confidence Interval (CI), 1.06–2.42]; p=0.03) for patients on ADT while twelve studies, including 336,330 patients, examined diabetes as an outcome, and the random effects model showed a RR of 1.43 ([95% CI, 1.28–1.59]; p< 0.01). After adjustment for publication bias, ADT was associated with a 25% increased risk for diabetes but was not associated with MetS. 4 studies, including 7,051 patients, examined hypertension as an outcome, and the random effects model showed a RR of 1.30 ([95% CI, 1.08–1.55]; p=0.18) in ADT patients.
Conclusions: In patients with PC, ADT was not associated with MetS and the association with diabetes was not as strong as previously reported. Our novel meta-analysis of hypertension showed that ADT increased the risk of hypertension by 30%. These results should be understood in the context of collaborating care between a patient's oncologist and primary care provider to optimize care.
Micro Abstract: Observational studies have shown ADT increases the risk for adverse cardiovascular events while randomized control trials argue against this association. We performed an updated meta-analysis on the cardiometabolic effects of ADT. ADT was not associated with the development of MetS and the association with diabetes was weaker than previously reported. ADT was associated with a 30% increased risk of hypertension.
Justin Swaby, Ankita Aggarwal, Akshee Batra, Anubhav Jain, Lakshya Seth, Nickolas Stabellini, Marcio Sommer Bittencourt, Darryl Leong, Zachary Klaassen, Pedro Barata, Nicolas Sayegh, Neeraj Agarwal, Martha Terris, Avirup Guha
Department of Cardiovascular Disease, Augusta University, Georgia, USA; Department of Cardiology, Ascension Providence Hospital, Michigan, USA; Department of Internal Medicine, University of Vermont, Vermont, USA; Department of Cardiology, Ascension Genesys Hospital, Garden city, Michigan, USA; Department of Hematology- Oncology, University Hospitals Cleveland Medical Center, Ohio, USA; Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada; Division of Surgery: Urology, Augusta University, Georgia, USA; Genitourinary Medical Oncology, Tulane University Medical School, Louisiana, USA; Huntsman Cancer Institute, University of Utah, Utah, USA
Source: Swaby J., Aggarwal A., Batra A. et al. "Association of Androgen Deprivation Therapy with Metabolic Disease in Prostate Cancer Patients: An Updated Meta-Analysis, Clinical Genitourinary Cancer." 2022. ISSN 1558-7673.