OBJECTIVES: To determine if androgen deprivation therapy (ADT) is associated with excess cardiac-specific mortality (CSM) in men with prostate cancer and no cardiovascular comorbidity, coronary artery disease risk factors, or congestive heart failure (CHF) or past myocardial infarction (MI).
SUBJECTS/PATIENTS AND METHODS: Five thousand seventy-seven men (median age, 69.5 years) with cT1c-T3N0M0 prostate cancer were treated with brachytherapy with or without neoadjuvant ADT (median duration, four months) between 1997 and 2006. Fine and Gray's competing risks analysis evaluated the association of ADT with CSM, adjusting for age, year of brachytherapy, and ADT treatment propensity score among men in groups defined by cardiac comorbidity.
RESULTS: After a median follow-up of 4.8 years, no association was detected between ADT and CSM in men with no cardiac risk factors (1.08% at 5 years for ADT vs 1.27% at five years for no ADT, adjusted hazard ratio (AHR) 0.83; 95% confidence interval (CI), 0.39-1.78; P=0.64; n=2653) or in men with diabetes mellitus, hypertension, or hypercholesterolemia (2.09% vs 1.97%, AHR, 1.33; 95% CI, 0.70-2.53; P=0.39; n=2168). However, ADT was associated with significantly increased CSM in men with CHF or MI (AHR 3.28; 95% CI 1.01-10.64; P=0.048; n=256). In this subgroup, the five-year cumulative incidence of CSM was 7.01% (95% CI 2.82-13.82%) for ADT vs 2.01% (95% CI 0.38-6.45%) for no ADT.
CONCLUSION: ADT was associated with a five percent absolute excess risk of CSM at five years in men with CHF or prior MI, suggesting that administering ADT to 20 men in this potentially vulnerable subgroup could result in one cardiac death.
Ziehr DR, Chen MH, Zhang D, Braccioforte MH, Moran BJ, Mahal BA, Hyatt AS, Basaria SS, Beard CJ, Beckman JA, Choueiri TK, D'Amico AV, Hoffman KE, Hu JC, Martin NE, Sweeney CJ, Trinh QD, Nguyen PL. Are you the author?
Harvard Medical School, Boston MA.
Reference: BJU Int. 2014 Aug 15. Epub ahead of print.