To evaluate the effect of androgen deprivation therapy (ADT) on kidney function in patients with prostate cancer (PC).
We analyzed the RADICAL-PC cohort (NCT03127631), a prospective study of patients with PC in 10 countries. Patients were categorized as ADT-exposed or ADT-naïve at baseline. We quantified kidney function using estimated glomerular filtration rate (eGFR), calculated from creatinine measurements obtained at annual visits over a 2 year follow-up period. We used a linear mixed-effects regression model to analyze the association between ADT and eGFR, adjusting for covariates known to affect renal function. We assessed the association between ADT and kidney injury during hospitalization using Cox proportional-hazards regression.
This analysis included 4 742 patients. The rate of eGFR decline over the 2 year follow-up period was greater in ADT-naïve patients (-1.322 [95% CI, -1.649 to -0.995] ml/min/1.73m2/year, p < 0.001) than ADT-exposed patients (-0.706 [95% CI, -1.097 to -0.316] ml/min/1.73m2/year, p < 0.001, interaction p = 0.025). Age and heart failure were associated with worsening eGFR, while higher baseline eGFR was associated with preserved eGFR. Duration of ADT use was not associated with change in eGFR (+ 0.04 [95% CI, -0.03 to + 0.10] ml/min/1.73m2/year per month of ADT use, p = 0.260). Kidney injury during hospitalization occurred in 135 (2.8%) patients, with no significant association with ADT (HR 1.37 [95% CI, 0.91 to 2.07], p = 0.135).
This analysis suggests that eGFR declines more modestly in patients initiating ADT than ADT-naïve patients. These findings do not preclude true kidney function decline due to ADT-mediated reduction in creatinine generation, and warrant further investigation.
International urology and nephrology. 2026 Mar 10 [Epub ahead of print]
Geethan Baskaran, Jehonathan H Pinthus, Sarah Karampatos, Kelvin K H Ng, Cristina Cano Garcia, Rajibul Mian, Lonnie Pyne, Scott Brimble, Laurence H Klotz, Vincent Fradet, Joseph B Selvanayagam, Avirup Guha, Celestia S Higano, Álvaro Avezum, Ludhmila A Hajjar, Germano Dallegrave Cavalli, Felipe H Valle, Emmanuelle Duceppe, Cesar D O L Dusilek, Bobby Shayegan, Rafaela Kirchner Piccoli, Juan Gomez-Mesa, Tamim Niazi, Margot K Davis, Jose E Cita Pardo, Patrick P Luke, Darryl Leong, RADICAL PC Investigators
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. ., Department of Surgery, Division of Urology, McMaster University, Hamilton, ON, Canada., Hamilton Health Sciences, Hamilton, ON, Canada., McMaster University, Hamilton, ON, Canada., Department of Urology, Goethe University Frankfurt, University Hospital, Frankfurt, Germany., Population Health Research Institute, Hamilton, ON, Canada., Department of Medicine, McMaster University, Hamilton, ON, Canada., Division of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, Canada., Sunnybrook Health Sciences Centre, Toronto, ON, Canada., Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, QC, Canada., Department of Cardiology, Division of Medicine, Flinders Medical Centre, Flinders University, Bedford Park, Australia., Cardio-Oncology Program, Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA, USA., University of British Columbia, Vancouver, BC, Canada., International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil., Cardio-Oncology Department, Instituto Do Coracao, University of São Paulo, São Paulo, Brazil., Division of Cardiology, Department of Internal Medicine, University of Western Ontario, London, ON, Canada., Division of Cardiology, Hospital das Clínicas de Porto Alegre, Porto Alegre, Brazil., Department of Medicine, Centre Hospitalier de L'Universite de Montreal, Montreal, QC, Canada., Rocio Hospital Research Center, Campo Largo, Paraná, Brazil., Division of Oncology, Department of Internal Medicine, Hospital de Clínicas de Ijuí, Ijuí, Brazil., Servicio de Cardiología, Fundación Valle del Lili, Cali, Colombia., Department of Oncology, Jewish General Hospital, McGill University, Montreal, QC, Canada., Pontificia Universidad Javeriana, Bogotá, Colombia., University of Western Ontario, London, ON, Canada.