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Association of androgen‐deprivation therapy with excess cardiac‐specific mortality in men with prostate cancer
Author(s) -
Ziehr David R.,
Chen MingHui,
Zhang Danjie,
Braccioforte Michelle H.,
Moran Brian J.,
Mahal Brandon A.,
Hyatt Andrew S.,
Basaria Shehzad S.,
Beard Clair J.,
Beckman Joshua A.,
Choueiri Toni K.,
D'Amico Anthony V.,
Hoffman Karen E.,
Hu Jim C.,
Martin Neil E.,
Sweeney Christopher J.,
Trinh QuocDien,
Nguyen Paul L.
Publication year - 2015
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12905
Subject(s) - medicine , androgen deprivation therapy , prostate cancer , hazard ratio , myocardial infarction , coronary artery disease , heart failure , comorbidity , diabetes mellitus , cardiology , oncology , confidence interval , cancer , endocrinology
Objectives To determine if androgen‐deprivation therapy ( ADT ) is associated with excess cardiac‐specific mortality ( CSM ) in men with prostate cancer and no cardiovascular comorbidity, coronary artery disease risk factors, or congestive heart failure ( CHF ) or past myocardial infarction ( MI ). Patients and Methods In all, 5077 men (median age 69.5 years) with cT1c ‐ T3N0M0 prostate cancer were treated with brachytherapy with or without neoadjuvant ADT (median duration 4 months) between 1997 and 2006. Fine and Gray competing risks analysis evaluated the association of ADT with CSM , adjusting for age, year of brachytherapy, and ADT treatment propensity score among men in groups defined by cardiac comorbidity. Results After a median follow‐up of 4.8 years, no association was detected between ADT and CSM in men with no cardiac risk factors (1.08% at 5 years for ADT vs 1.27% at 5 years for no ADT , adjusted hazard ratio ( AHR ) 0.83; 95% confidence interval ( CI ), 0.39–1.78; P = 0.64; n = 2653) or in men with diabetes mellitus, hypertension, or hypercholesterolaemia (2.09% vs 1.97%, AHR 1.33; 95% CI 0.70–2.53; P = 0.39; n = 2168). However, ADT was associated with significantly increased CSM in men with CHF or MI ( AHR 3.28; 95% CI 1.01–10.64; P = 0.048; n = 256). In this subgroup, the 5‐year cumulative incidence of CSM was 7.01% (95% CI 2.82–13.82%) for ADT vs 2.01% (95% CI 0.38–6.45%) for no ADT . Conclusion ADT was associated with a 5% absolute excess risk of CSM at 5 years in men with CHF or prior MI , suggesting that administering ADT to 20 men in this potentially vulnerable subgroup could result in one cardiac death.