PURPOSE: Observational data suggest that androgen deprivation therapy increases the risk of diabetes and cardiovascular disease.
Using data from the population based PCOS we evaluated whether age at diagnosis and comorbidity impact the association of androgen deprivation therapy with incident diabetes and cardiovascular disease.
MATERIALS AND METHODS: We identified men with nonmetastatic prostate cancer diagnosed from 1994 to 1995 who were followed through 2009 to 2010. We used multivariable logistic regression models to assess the relationship of androgen deprivation therapy exposure (2 or fewer years, greater than 2 years or none) with incident diabetes and cardiovascular disease, adjusting for age at diagnosis, race, stage and comorbidity.
RESULTS: Of 3,526 eligible study participants 2,985 without diabetes and 3,112 without cardiovascular disease comprised the cohorts at risk. Androgen deprivation therapy was not associated with an increased risk of diabetes or cardiovascular disease in men diagnosed with prostate cancer before age 70 years. Prolonged androgen deprivation therapy and increasing age at diagnosis in older men was associated with an increased risk of diabetes (at age 76 years OR 2.1, 95% CI 1.0-4.4) and cardiovascular disease (at age 74 years OR 1.9, 95% CI 1.0-3.5). Men with comorbidities were at greater risk for diabetes (OR 4.3, 95% CI 2.3-7.9) and cardiovascular disease (OR 8.1, 95% CI 4.3-15.5) than men without comorbidities.
CONCLUSIONS: Prolonged androgen deprivation therapy exposure increases the risk of cardiovascular disease and diabetes in men diagnosed with prostate cancer who are older than approximately 75 years, especially those with other comorbidities. Older men who receive prolonged androgen deprivation therapy should be closely monitored for diabetes and cardiovascular disease.
Written by:
Morgans AK, Fan KH, Koyama T, Albertsen PC, Goodman M, Hamilton AS, Hoffman RM, Stanford JL, Stroup AM, Resnick MJ, Barocas DA, Penson DF. Are you the author?
School of Medicine, Vanderbilt University, Nashville, Tennessee; Center for Quantitative Sciences and Department of Biostatistics, Vanderbilt University, Nashville, Tennessee; Geriatric Research, Education and Clinical Center, Tennessee Valley Veterans Administration Healthcare System, Nashville, Tennessee; University of Connecticut Health Center, Farmington, Connecticut; Emory University, Atlanta, Georgia; Keck School of Medicine, University of Southern California, Los Angeles, California; University of New Mexico, Albuquerque, New Mexico; Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Utah, Salt Lake City, Utah.
Reference: J Urol. 2014 Nov 11. pii: S0022-5347(14)04835-6.
doi: 10.1016/j.juro.2014.11.006
PubMed Abstract
PMID: 25451829