Association of androgen deprivation therapy with thromboembolic events in patients with prostate cancer: a systematic review and meta-analysis

Guo, Zhenlang; Huang, Yao; Gong, Leiliang; Gan, Shu; Chan, Franky L.; Gu, Chiming; Xiang, Shulin; Wang, Shusheng

doi:10.1038/s41391-018-0059-4

Cited by 24 publications

(27 citation statements)

References 34 publications

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“…Our data confirmed this tenet, because most men died of causes other than prostate cancer, and long-term ADT ≥2 years worsened not only OCM but also OS. Several adverse effects of ADT have been reported: 5 weight gain, decreased muscle mass and increased insulin resistance, decreased bone mineral density, decreased libido and sexual dysfunction, hot flashes, gynecomastia, reduced testicle size, anemia, fatigue, diabetes, cardiovascular events (myocardial infarction [MI] and sudden cardiac death) [ 14 , 15 ], cerebrovascular diseases [ 15 ], kidney injury [ 16 ], dementia [ 17 ], and thromboembolic events [ 18 , 19 ]. Abdollah et al, in their study including 137,524 patients with non-metastatic prostate cancer treated between 1995 and 2009, reported that treatment with medical ADT may increase the risk of OCM [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Potential Risk of Other-Cause Mortality Due to Long-Term Androgen Deprivation Therapy in Elderly Patients with Clinically Localized Prostate Cancer Treated with Radiotherapy—A Confirmation Study

Yamazaki

Masui

Suzuki

et al. 2020

JCM

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Androgen deprivation therapy (ADT) is used to improve overall survival (OS) in prostate cancer treatment; however, we encountered that long-term ADT in elderly patients may be related to high other-cause mortality (OCM). This study aimed to confirm the potential risk associated with long-term ADT in elderly patients using a different large cohort. A comparison analysis was conducted between the ≥2- and <2-year ADT groups using open, large data from 1840 patients with clinically localized prostate cancer treated with radiotherapy (1172 treated with high-dose-rate brachytherapy (HDR) + external beam radiotherapy (EBRT) and 668 treated with external beam radiotherapy). The OCM-free survival (OCMFS), overall survival, and prostate cancer-specific survival rates were measured. The 10-year OCMFS rates in patients aged ≥75 years were 94.6% and 86% in the <2- and ≥2-year ADT groups, respectively, but were 96.3% and 93.5% (p = 0.0006) in their younger counterparts. If dividing into HDR and EBRT groups. This inclination was found in brachytherapy group but not in EBRT group. The overall survival rate was also lower in the elderly patients in the ≥2-year ADT group than in the <2-year ADT group; however, the 10-year prostate cancer-specific survival rate was the same in both groups. Long-term ADT in elderly patients resulted in not only higher OCM rates but also poorer OS rates; therefore, longer-term ADT in elderly patients should be performed with meticulous care.

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Section: Discussionmentioning

confidence: 99%

Potential Risk of Other-Cause Mortality Due to Long-Term Androgen Deprivation Therapy in Elderly Patients with Clinically Localized Prostate Cancer Treated with Radiotherapy—A Confirmation Study

Yamazaki

Masui

Suzuki

et al. 2020

JCM

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“…Many meta-analyses have shown the effects of ADT on cognitive function, cardiovascular complications, and thromboembolic events in PCa patients [41,42,43,44,45]; however, to the best of our knowledge, our study is the first to show the effect of ADT on bone health in patients with PCa. Furthermore, we have identified a significant relationship between ADT and BMD reduction.…”

Section: Discussionmentioning

confidence: 63%

Effect of Androgen-Deprivation Therapy on Bone Mineral Density in Patients with Prostate Cancer: A Systematic Review and Meta-Analysis

Kim

Lee

Kim

et al. 2019

JCM

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We aimed to evaluate the change in bone mineral density (BMD) in patients with prostate cancer (PCa) receiving androgen deprivation therapy (ADT) compared to those with PCa or other urologic conditions not receiving ADT. Literature searches were conducted throughout October 2018. The eligibility of each study was assessed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the Participant, Intervention, Comparator, Outcome, and Study design method. The outcomes analyzed were the mean difference (MD) of percent changes in BMD of lumbar spine, femur neck, and total hip. Five prospective cohort studies with a total of 533 patients were included in the present study. Statistically significant decreases of BMD change relative to the control group were observed in the ADT treatment group in the lumbar spine (MD −3.60, 95% CI −6.72 to −0.47, P = 0.02), femoral neck (MD −3.11, 95% CI −4.73 to −1.48, P = 0.0002), and total hip (MD −1.59, 95% CI −2.99 to −0.19, P = 0.03). There is a significant relationship between ADT and BMD reduction in patients with PCa. Regular BMD testing and the optimal treatment for BMD loss should, therefore, be considered in patients with PCa undergoing ADT.

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“…There was also a significant association between ADT and hypertension, particularly for second generation therapies, abiraterone and enzalutamide. Other vascular disorders like thromboembolic events also showed a significant association with GnRHa alone, CAB, anti-androgen alone, oestrogen and orchiectomy (10,18). For vasomotor flashing, enzalutamide had a significant increased risk and anti-androgens a significantly lower risk than other types of ADT (14,15,25,29,57).…”

Section: Discussionmentioning

confidence: 91%

“…Population-based studies of men receiving ADT for PC have revealed an association between ADT and increased risk of thromboembolic events such as deep vein thrombosis (DVT) and pulmonary embolus (PE). Two meta-analyses examined the evidence for ADT associated thromboembolic events (10,18).…”

Section: B Thromboembolic Eventsmentioning

confidence: 99%

“…One restricted the analysis to five cohort studies which compared GnRH agonists alone, GnRH agonists + anti-androgens, anti-androgens alone and orchiectomy with no ADT (10 (10). The other systematic review included oestrogens in addition to the above-mentioned forms of ADT and drew evidence from 20 studies comparing ADT with no ADT, short term ADT and IADT (18).…”

Section: B Thromboembolic Eventsmentioning

confidence: 99%

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Incidence of the adverse effects of androgen deprivation therapy for prostate cancer: a systematic literature review

Edmunds

Tuffaha

Galvão

et al. 2020

Support Care Cancer

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PurposeAndrogen deprivation therapy (ADT) has broad application in the treatment of prostate cancer (PC) and is associated with numerous, debilitating adverse effects. Increasing use of ADT for PC, longer timeframe for treatment (increased uptake of PSA testing and earlier diagnosis), as well as improved survival and an ageing population, means patients can live for a considerable period of time on or after ADT, experiencing these adverse effects. A number of systematic reviews of adverse effects of ADT for PC exist, however, no single systematic review has previously examined the evidence for all adverse effects, including newer forms of ADT. MethodsA systematic review of existing systematic reviews of ADT for PC was conducted (2010 -February 2019), as per Cochrane guidelines, to identify the highest level of risk/incidence evidence available, supplemented by evidence drawn from individual studies where no systematic review existed. ResultsIncidence data was generated for 19 adverse effect sub groups, classified according to the common terminology criteria for adverse events (CTCAE). ConclusionIncidence of adverse effects provides valuable information for future burden of disease studies. This information can better guide clinical management to reduce symptoms for patients and assist patients to make more informed decisions about their treatment, potentially improving disease outcomes. It also highlights the importance of supportive care for PC patients receiving ADT and their carers. For analysts conducting economic evaluations, the inclusion of adverse effects in PC decision analytic models can provide more comprehensive and accurate information for decision makers.

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Association of androgen deprivation therapy with thromboembolic events in patients with prostate cancer: a systematic review and meta-analysis

Cited by 24 publications

References 34 publications

Potential Risk of Other-Cause Mortality Due to Long-Term Androgen Deprivation Therapy in Elderly Patients with Clinically Localized Prostate Cancer Treated with Radiotherapy—A Confirmation Study

Potential Risk of Other-Cause Mortality Due to Long-Term Androgen Deprivation Therapy in Elderly Patients with Clinically Localized Prostate Cancer Treated with Radiotherapy—A Confirmation Study

Effect of Androgen-Deprivation Therapy on Bone Mineral Density in Patients with Prostate Cancer: A Systematic Review and Meta-Analysis

Incidence of the adverse effects of androgen deprivation therapy for prostate cancer: a systematic literature review

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