Dose-dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events

OBJECTIVE - To investigate the dose-dependent effect of androgen deprivation therapy (ADT) on adverse cardiac events in elderly men with non-metastatic prostate cancer (PCa) stratified according to life expectancy.

METHODS - A total of 50 384 men diagnosed with localized PCa between 1992 and 2007 were identified within the Surveillance, Epidemiology, and End Results registry areas. We compared those who received ADT within 2 years of PCa diagnosis with those who did not, calculated as monthly equivalent doses of GnRH agonists (<8, ≥8 doses), or orchiectomy. Men were further stratified according to life expectancy (10 years). Adjusted Cox hazard models assessed the risk of new-onset coronary heart disease (CHD), acute myocardial infarction (AMI), sudden cardiac death (SCD) and cardiac-related interventions, as well as any of these events.

RESULTS - Overall, patients receiving GnRH agonists were more likely to experience a cardiac event, with the most pronounced effect among those receiving ≥8 doses (hazard ratio [HR] 10 years: 1.16, 95% CI 1.04-1.29; P = 0.006). Finally, orchiectomy was not associated with overall cardiac events, AMI or SCD, and was protective with regard to cardiac-related interventions (HR 0.78, 95% CI 0.68-0.90, P = 0.001).

CONCLUSIONS - Exposure to ADT with GnRH agonists is associated with an increased risk of cardiac events in elderly men with localized PCa and a decent life expectancy. Clinicians should carefully weigh the risks and benefits of ADT in patients with a prolonged life expectancy. Routine screening and lifestyle interventions are warranted in at-risk subpopulations treated with ADT.

BJU Int. 2015 Jun 13. doi: 10.1111/bju.13203. [Epub ahead of print]

Schmid M1,2, Sammon JD3, Reznor G1, Kapoor V3, Speed JM1, Abdollah FA3, Sood A3, Chun FK2, Kibel AS1, Menon M3, Fisch M2, Sun M1, Trinh QD1.

1 Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
2 Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
3 Vattikuti Urology Institute Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.