Androgen Deprivation Therapy for Prostate Cancer Does Not Increase Cardiovascular Mortality in the Long Term

Abstract

Objective: To determine if 6 months of neo-adjuvant androgen deprivation is associated with the long-term risk of cardiac mortality. Methods: In the TROG 96.01 trial, 802 men with locally advanced prostate cancer were randomized to radiotherapy either alone or with 3 or 6 months of neo-adjuvant androgen deprivation therapy (NADT). Competing risk methodology was used to derive the cumulative incidence of fatal cardiac events. Results: At 10 years, the cumulative incidence of fatal cardiac events for the radiation therapy alone arm was 7.54% compared to a nonstatistically significant decreased incidence of 6.44% in the 6-month NADT arm (p = 0.65). Men aged over 65 years were not at an increased risk. Additional androgen deprivation therapy given as secondary treatment at tumor progression did not confer an increased risk. Conclusion: These data suggest that fatal cardiac events are not more common in men receiving up to 6 months of NADT.

Androgen deprivation and radiotherapy in patients with prostate cancer and cardiovascular risk factors: clinical controversies

“…They concluded that longer duration of adjuvant GnRHa therapy did not appear to increase CV mortality. Other studies and a recent meta-analysis have reported similar findings [4,16,19,25].…”

“…The benefit of ADT in patients with an optimal indication prevails over the potential risk of CV mortality [11,16,19,22,26]. 3.…”

“…On the other hand, the subgroup of patients with intermediate-risk disease seems to benefit from a short course (4-6 months) of neoadjuvant and concomitant ADT [16][17][18]. The first assumption of the expert panel was that, although there is a recognized association between ADT and CV risk (especially in patients with CV risk factors), no direct cause-effect relationship has been demonstrated to date, since the available evidence derives from retrospective studies and in some cases data are contradictory.…”

“…Several randomized clinical trials of ADT and RT have investigated the potential association between ADT and CV events and failed to show an increase in CV mortality [4,16,17]. Two recent reports conducted to assess the interaction between ADT, comorbidity, and allcause mortality in patients with localized PCa treated with hormone therapy and RT for 4 and 6 months found an increased risk of all-cause mortality among patients with moderate or severe CV comorbidity, but not among men with no comorbidity or a single CV risk factor [17,18].…”

Androgen deprivation therapy and cardiovascular complications

“…Daskavich et al (7) published long-term follow-up of the Prostate Cancer Outcomes Study showing that older men (aged ≥ 60 years) with multiple comorbidities are far more likely to die from other causes than prostate cancer. On the other hand, some studies have found no association between ADT and increased cardiovascular risk or morbidity (8)(9)(10)(11)(12)(13)(14). Thus, the relationship between ADT and cardiovascular diseases remains still controversial.…”