Androgen deprivation therapy (ADT) is associated with coronary heart disease and diabetes in men with prostate cancer (PCa); however, controversy exists regarding ADT and cardiovascular mortality (CVM) with limited data for lower risk disease.
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We conducted a hypothesis-generating retrospective analysis to evaluate the relationship between short-course ADT and CVM in patients with clinically localized PCa enrolled in a phase III trial.
A total of 1979 men with clinically localized (T1b-2b, prostate-specific antigen [PSA]
The Cox proportional hazards model assessed overall survival. The Fine-Gray proportional hazards model assessed disease-specific survival (DSS) and CVM. Covariates included age, race, weight, baseline cardiovascular disease, baseline diabetes, baseline hypertension, Gleason score, T stage, and PSA.
Short-course ADT improved overall survival and DSS and was not associated with an increased risk of CVM. Overall, 191 cardiovascular-related deaths were observed. At 10 yr, 83 patients (cumulative incidence rate: 10%) receiving RT and ADT versus 95 patients (cumulative incidence rate: 11%) receiving RT alone experienced CVM. The treatment arm was not associated with increased CVM (unadjusted hazard ratio: 1. 07; confidence interval, 0. 81-1. 42; p=0. 62). Increased CVM was not observed in patients at low risk of PCa death or at high risk of cardiac-related death.
Data from patients enrolled in RTOG 94-08 support the hypothesis that ADT does not increase CVM risk in men with clinically localized PCa treated with short-course GnRH agonist therapy. These data support ADT use in settings with proven survival benefit.
We investigated the controversial relationship between hormone therapy and cardiovascular mortality in men with prostate cancer (PCa) treated with radiation in a large randomized trial. Our data suggest that hormone therapy does not increase the risk of cardiovascular death in patients with clinically localized PCa and support the use of such therapy in settings with proven survival benefit.
European urology. 2015 Sep 08 [Epub ahead of print]
Justin C Voog, Rebecca Paulus, William U Shipley, Matthew R Smith, David G McGowan, Christopher U Jones, Jean-Paul Bahary, Kenneth L Zeitzer, Luis Souhami, Mark H Leibenhaut, Marvin Rotman, Siraj M Husain, Elizabeth Gore, Adam Raben, Susan Chafe, Howard M Sandler, Jason A Efstathiou
Harvard Radiation Oncology Program, Boston, MA, USA. , NRG Oncology Statistics and Data Management Center, Philadelphia, PA, USA. , Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. , Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. , Cross Cancer Institute, Edmonton, Alberta, Canada. , Sutter Cancer Centers (Radiological Associates of Sacramento), Sacramento, CA, USA. , CHUM-Hospital Norte-Dame, Montreal, Quebec, Canada. , Department of Radiation Oncology, Albert Einstein Medical Center, Philadelphia, PA, USA. , McGill University, Montreal, Quebec, Canada. , Sutter Cancer Centers (Radiological Associates of Sacramento), Sacramento, CA, USA. , Brooklyn MB-CCOP/SUNY Downstate, Brooklyn, NY, USA. , Tom Baker Cancer Center, Calgary, Alberta, Canada. , Medical College of Wisconsin, Milwaukee, WI, USA. , Christiana Care Health Services, Inc. CCOP, Newark, DE, USA. , Cross Cancer Institute, Edmonton, Alberta, Canada. , Cedars-Sinai Medical Center, Los Angeles, CA, USA. , Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.