Medical androgen deprivation therapy and increased non-cancer mortality in non-metastatic prostate cancer patients aged ≥66 years.

PURPOSE - To examine the potential relationship between androgen deprivation therapy and other-cause mortality (OCM) in patients with prostate cancer treated with medical primary-androgen deprivation therapy, prostatectomy, or radiation.

METHODS - A total of 137,524 patients with non-metastatic PCa treated between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included. Cox-regression analysis tested the association of ADT with OCM. A 40-item comorbidity score was used for adjustment.

RESULTS - Overall, 9.3% of patients harbored stage III-IV disease, and 57.7% of patients received ADT. The mean duration of ADT exposure was 22.9 months (median: 9.1; IQR: 2.8-31.5). Mean and median follow-up were 66.9, and 60.4 months, respectively. At 10 years, overall-OCM rate was 36.5%; it was 30.6% in patients treated without ADT vs. 40.1% in patients treated with ADT (p < 0.001). In multivariable-analysis, ADT was associated with an increased risk of OCM (Hazard-ratio [HR]: 1.11, 95% Confidence-interval [95% CI]: 1.08-1.13). Patients with no comorbidity (10-year OCM excess risk: 9%) were more subject to harm from ADT than patients with high comorbidity (10-year OCM excess risk: 4.7%).

CONCLUSIONS - In patients with PCa, treatment with medical ADT may increase the risk of mortality due to causes other than PCa. Whether this is a simple association or a cause-effect relationship is unknown and warrants further study in prospective studies.

Eur J Surg Oncol. 2015 Jul 15. pii: S0748-7983(15)00522-3. doi: 10.1016/j.ejso.2015.06.011. [Epub ahead of print]

Abdollah F1, Sammon JD2, Reznor G3, Sood A2, Schmid M4, Klett DE2, Sun M5, Aizer AA6, Choueiri TK7, Hu JC8, Kim SP9, Kibel AS3, Nguyen PL10, Menon M2, Trinh QD3.

1 Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
2 Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
3 Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
4 Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
5 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
6 Harvard Radiation Oncology Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
7 Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
8 Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, USA.
9 Department of Urology, Yale University, New Haven, CT, USA.
10 Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

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