Hormonal Therapy After Prostatectomy May Increase Cardiovascular Death
- From: MarilynMann <mannm@xxxxxxxxxxx>
- Date: Wed, 10 Oct 2007 13:03:45 -0000
Hormonal Therapy After Prostatectomy May Increase Cardiovascular
Death
Men who receive androgen-deprivation therapy (ADT) after undergoing
prostatectomy for prostate cancer may be at increased risk for
cardiovascular death, reports an industry-funded study in the Journal
of the National Cancer Institute.
Researchers examined outcomes among nearly 5000 patients who had been
treated for localized prostate cancer; two-thirds had undergone
radical prostatectomy, while the rest received nonsurgical therapy.
Overall, 20% also received ADT (median duration, 4 months).
During a median follow-up of 4 years, ADT use was associated with
increased risk for cardiovascular death among prostatectomy patients
(adjusted hazard ratio, 2.6). For patients treated nonsurgically, a
higher 5-year estimate of cardiovascular death with ADT use, observed
only in patients 65 or older, did not achieve statistical
significance.
The authors say their findings "underscore the importance of careful
cardiovascular evaluation and intervention before initiating ADT in
patients with localized prostate cancer."
* * *
Journal of the National Cancer Institute Advance Access published
online on October 9, 2007
Androgen Deprivation Therapy for Localized Prostate Cancer and the
Risk of Cardiovascular Mortality
Henry K. Tsai, Anthony V. D'Amico, Natalia Sadetsky, Ming-Hui Chen,
Peter R. Carroll
Affiliations of authors: Harvard Radiation Oncology Program, Harvard
Medical School, Boston, MA (HKT); Department of Radiation Oncology,
Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston,
MA (AVD); Department of Urology, University of California, San
Francisco, CA (NS, PRC); Department of Statistics, University of
Connecticut, Storrs, CT (MHC)
Correspondence to: Henry K. Tsai, MD, Harvard Radiation Oncology
Program, 375 Longwood Ave, Boston, MA 02215 (e-mail:
hktsai@xxxxxxxxxxxxxxxx).
Background: We investigated whether androgen deprivation therapy (ADT)
use is associated with an increased risk of death from cardiovascular
causes in patients treated for localized prostate cancer.
Methods: From the Cancer of the Prostate Strategic Urologic Research
Endeavor database, data on 3262 patients treated with radical
prostatectomy and 1630 patients treated with external beam radiation
therapy, brachytherapy, or cryotherapy for localized prostate cancer
were included in this analysis. Competing risks regression analyses
were performed to assess whether use of ADT was associated with a
shorter time to death from cardiovascular causes after controlling for
age (as a continuous variable) and the presence of baseline
cardiovascular disease risk factors. All tests for statistical
significance were two-sided.
Results: The median follow-up time was 3.8 years (range = 0.1-11.3
years). Among the 1015 patients who received ADT, the median duration
of ADT use was 4.1 months (range = 1.0-32.9 months). In a competing
risks regression analysis that controlled for age and risk factors for
cardiovascular disease, both ADT use (adjusted hazard ratio [HR] =
2.6; 95% confidence interval [CI] = 1.4 to 4.7; P = .002) and age
(adjusted HR = 1.07; 95% CI = 1.02 to 1.1; P = .003) were associated
with statistically significantly increased risks of death from
cardiovascular causes in patients treated with radical prostatectomy.
Among patients 65 years or older treated with radical prostatectomy,
the 5-year cumulative incidence of cardiovascular death was 5.5% (95%
CI = 1.2% to 9.8%) in those who received ADT and 2.0% (95% CI = 1.1%
to 3.0%) in those who did not. Among patients 65 years or older
treated with external beam radiation therapy, brachytherapy, or
cryotherapy, ADT use was associated with a higher cumulative incidence
of death from cardiovascular causes, but the difference did not reach
statistical significance.
Conclusions: The use of ADT appears to be associated with an increased
risk of death from cardiovascular causes in patients undergoing
radical prostatectomy for localized prostate cancer.
CONTEXT AND CAVEATS
Prior knowledge
Androgen deprivation therapy (ADT) is increasingly being used in
combination with local therapy to treat patients with high-risk
localized prostate cancer. However, ADT can lead to conditions that
are included in the metabolic syndrome, which increases the risk of
coronary artery disease.
Observational retrospective study using data from the Cancer of the
Prostate Strategic Urologic Research Endeavor registry of patients
with biopsy-proven prostate adenocarcinoma.
ADT use appears to be associated with a statistically significantly
increased risk of death from cardiovascular causes among patients aged
65 years or older undergoing radical prostatectomy for localized
prostate cancer. The 5-year cumulative incidence of cardiovascular
death was 5.5% among patients who received ADT and 2.0% among those
who did not. Among patients aged 65 years or older treated with
external beam radiation therapy, brachytherapy, or cryotherapy, ADT
use was associated with an increased cumulative incidence of death
from cardiovascular causes, but the increase was not statistically
significant.
Careful cardiovascular evaluation and intervention are advisable
before initiating ADT in patients with localized prostate cancer.
The study had a relatively short follow-up with few fatal
cardiovascular events observed. All possible risk factors for
cardiovascular death could not be controlled for because of the
study's retrospective nature.
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