Drugs for metabolic conditions and prostate cancer death in men on GnRH agonists

It is unclear whether metabolic syndrome and its related drugs is affecting treatment response in men with prostate cancer (PCa) on Gonadotropin releasing Hormone (GnRH) agonists. We aimed to evaluate whether drugs for metabolic conditions influence PCa-specific mortality in men starting GnRH agonists.

We selected all men receiving GnRH agonists as primary treatment in PCBaSe Sweden (n=9,267). Use of drugs for metabolic conditions (i.e. anti-diabetes, anti-dyslipidaemia, and anti-hypertension) in relation to all cause, cardiovascular disease (CVD), and PCa-specific death was studied using multivariate Cox proportional hazard and Fine and Gray competing regression models.

6,322 (68%) men used at least one drug for a metabolic condition at GnRH agonist initiation: 46% on antihypertensive drugs only, 32% on drugs for dyslipidaemia and hypertension and about 10% on drugs for more than two metabolic conditions. Cox models indicated a weak increased risk of PCa death in men who are on drugs for hypertension only (HR: 1.12 (95%CI: 1.03-1.23)) or drugs for hyperglycaemia (HR: 1.19 (95%CI: 1.06-1.35)) at GnRH agonist initiation. However, upon taking into account competing risk from CVD death, none of the drugs for metabolic conditions were associated with an increased risk of PCa death.

We did not find evidence for a better or worse response to GnRH agonists in men with PCa who were also on drugs for hypertension, dyslipidaemia, or hyperglycaemia. This article is protected by copyright. All rights reserved.

BJU international. 2017 Sep 20 [Epub ahead of print]

Cecilia Bosco, Chloe Wong, Hans Garmo, Danielle Crawley, Lars Holmberg, Niklas Hammar, Jan Adolfsson, Pär Stattin, Mieke Van Hemelrijck

King's College London, Division of Cancer Studies, Translational Oncology & Urology Research, London, UK., Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden., CLINTEC department, Karolinska Institutet, Stockholm, Sweden., Department of Surgical Sciences, Uppsala University, Sweden.