Effectiveness of Primary Androgen-Deprivation Therapy for Clinically Localized Prostate Cancer

Potosky, Arnold L.; Haque, Reina; Cassidy‐Bushrow, Andrea E.; Yood, Marianne Ulcickas; Jiang, Miao; Tsai, Huei‐Ting; Luta, George; Keating, Nancy L.; Smith, Matthew R.; Eeden, Stephen K. Van Den

doi:10.1200/jco.2013.52.5782

Cited by 70 publications

(38 citation statements)

References 33 publications

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“…Indeed, some studies hypothesize that the decreased overall survival in men treated with ADT is related to the higher rates of cardiovascular deaths in this population [38,39]; however, the mere presence of baseline comorbidities associated with the development of cardiovascular disease may not modify the risk attributable to ADT [40]. As such, it is important to consider the cardiovascular risk of ADT in patient populations for whom no cancer benefit of treatment has been documented; for example, in patients with low-risk localized PCa [32,41].…”

Section: Discussionmentioning

confidence: 99%

Dose‐dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events

et al. 2015

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ObjectivesTo investigate the dose-dependent effect of androgen deprivation therapy (ADT) on adverse cardiac events in elderly men with non-metastatic prostate cancer (PCa) stratified according to life expectancy. Patients and MethodsA total of 50 384 men diagnosed with localized PCa between 1992 and 2007 were identified within the Surveillance, Epidemiology, and End Results registry areas. We compared those who received ADT within 2 years of PCa diagnosis with those who did not, calculated as monthly equivalent doses of GnRH agonists (<8, ≥8 doses), or orchiectomy. Men were further stratified according to life expectancy (<5 years, 5-10 years and >10 years). Adjusted Cox hazard models assessed the risk of new-onset coronary heart disease (CHD), acute myocardial infarction (AMI), sudden cardiac death (SCD) and cardiac-related interventions, as well as any of these events. ResultsOverall, patients receiving GnRH agonists were more likely to experience a cardiac event, with the most pronounced effect among those receiving ≥8 doses (hazard ratio [HR] <8 doses: 1.13, 95% confidence interval [CI] 1.09-1.16, and HR ≥8 doses: 1.18, 95% CI 1.14-1.22; both P < 0.001). The effect of prolonged (≥8 doses) GnRH agonist use on cardiac events was sustained across all strata of life expectancy; however, there was no effect among men with a life expectancy of <5 years and when use of GnRH agonists was limited to <8 doses (HR 0.99, 95% CI 0.67-1.46; P = 0.964). The use of GnRH agonists was associated with a higher risk of CHD (HR <8 doses: 1.13, 95% CI 1.09-1.17 and HR ≥8 doses: 1.17, 95% CI 1.13-1.21; both P < 0.001). Conversely, the use of GnRH was generally not associated with an increased risk of AMI or SCD, except for men who received ≥8 doses of GnRH agonists and had a life expectancy of ≥5 years, who were at a significantly higher risk of SCD (HR for life expectancy 5-10 years: 1.19, 95% CI 1.06-1.33; P = 0.003 and HR for life expectancy >10 years: 1.16, 95% CI 1.04-1.29; P = 0.006). Finally, orchiectomy was not associated with overall cardiac events, AMI or SCD, and was protective with regard to cardiac-related interventions (HR 0.78, 95% CI 0.68-0.90, P = 0.001). ConclusionExposure to ADT with GnRH agonists is associated with an increased risk of cardiac events in elderly men with localized PCa and a decent life expectancy. Clinicians should carefully weigh the risks and benefits of ADT in patients with a prolonged life expectancy. Routine screening and lifestyle interventions are warranted in at-risk subpopulations treated with ADT.

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Section: Discussionmentioning

confidence: 99%

Dose‐dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events

et al. 2015

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“…Patients who receive ADT may need injections every several months and are at an advanced stage of disease that requires more checkups. 6 Given that study outcomes were identified by using administrative data, individuals with more frequent visits may be more likely to be diagnosed with adverse events because of a greater number of physician encounters and more numerically likely to have an instance of the defined study outcome term appear in the medical record as a result of a greater number of records.…”

Section: 3mentioning

confidence: 99%

Association of Androgen Deprivation Therapy With Alzheimer’s Disease: Unmeasured Confounders

Leow

Cole

Sun

et al. 2016

JCO

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“…The effect of pADT on patients with LE <5 yr is less clear, and may be beneficial for some men with shorter LE (Supplementary Table 1). A study by Potosky et al [29] recently examined the effectiveness of pADT using a propensity score standardized analysis and relying on data from the HMO Cancer Research Network. In their study, pADT was associated with a lack of overall survival benefit.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Declining Use and the Adverse Effect of Primary Androgen Deprivation on All-cause Mortality in Elderly Men with Prostate Cancer

et al. 2015

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Effectiveness of Primary Androgen-Deprivation Therapy for Clinically Localized Prostate Cancer

Cited by 70 publications

References 33 publications

Dose‐dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events

Dose‐dependent effect of androgen deprivation therapy for localized prostate cancer on adverse cardiac events

Association of Androgen Deprivation Therapy With Alzheimer’s Disease: Unmeasured Confounders

Patterns of Declining Use and the Adverse Effect of Primary Androgen Deprivation on All-cause Mortality in Elderly Men with Prostate Cancer

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