Authors: Gandaglia G, Sun M, Popa I, Schiffmann J, Abdollah F, Trinh QD, Saad F, Graefen M, Briganti A, Montorsi F, Karakiewicz PI
Title: The Impact of the Androgen Deprivation Therapy on the Risk of Coronary Heart Disease in Patients with Non-Metastatic Prostate Cancer: A Population-Based Study.
Journal: BJU Int :-
Date: 2014 Mar 10
Abstract: OBJECTIVE: To examine and quantify the contemporary association between ADT and three separate endpoints: coronary artery disease (CAD), acute myocardial infarction (AMI), and sudden cardiac death (SCD), in a large United States contemporary cohort of PCa patients. MATERIALS AND METHODS: Overall, 140,474 patients diagnosed with non-metastatic PCa between 1995 and 2009 within the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database were abstracted. Patients treated with ADT and those not receiving ADT were matched using propensity-score methodology. Ten-year CAD, AMI, and SCD rates were estimated. Competing-risks regression analyses tested the association between the type of ADT (GnRH agonists vs. bilateral orchiectomy) and CAD, AMI, and SCD, after adjusting for the risk of dying during follow-up. RESULTS: Overall, the 10-year rates of CAD, AMI, and SCD were 25.9, 15.6, and 15.8%, respectively. After stratification according to ADT status (ADT-naïve vs. GnRH agonists vs. bilateral orchiectomy), the CAD rates were 25.1 vs. 26.9 vs. 23.2%, the AMI rates were 14.8 vs. 16.6 vs. 14.8%, and the SCD rates were 14.2 vs. 17.7 vs. 16.4%, respectively. In competing-risks multivariable regression analyses, the administration of GnRH agonists (all P<0.001), but not bilateral orchiectomy (all P≥0.7), was associated with higher risk of CAD, AMI, and SCD. CONCLUSIONS: The administration of GnRH agonists, but not orchiectomy, is still associated with a significantly increased risk of CAD, AMI, and, especially, SCD in patients with non-metastatic PCa. Alternative forms of ADT should be considered in patients at higher risk of CV events.
Last Modified: 03 Sep 2013