Cardiovascular events associated with androgen deprivation therapy in patients with prostate cancer: A systematic review and meta-analysis.

Abstract

40 Background: A recently published meta-analysis of randomized clinical trials (RCT) showed that androgen deprivation therapy (ADT) did not significantly increase cardiovascular mortality in prostate cancer patients. However, cardiovascular morbidity, which can impact quality of life, was not evaluated. Objectives: To evaluate the risk of cardiovascular morbidity and mortality associated with long-term ADT in patients with prostate cancer. Methods: We conducted a literaturesearch from 1960 and June 2012. We selected RCT and large cohort studies that evaluated first-line endocrine therapy, ADT greater than 6 months, and follow up greater than 1 year. Results: Thirteen studies (137,658 patients) were included. Of four cohort studies, 126,898 patients were included and 10,760 patients were part of nine RCTs. Analysis of the RCTs showed no differences in development of acute myocardial infarction (AMI) (OR 1.23; 95% CI: 0.92 – 1.64; I2: 0%) or stroke (OR 1.02; 95% CI: 0.71 – 1.46; I2: 0%) among patients receiving ADT or not. The analysis of three randomized studies that reported other nonfatal cardiovascular events demonstrated a significant increase in such events in the group receiving ADT (OR 1.55; 95% CI: 1.09 – 2.20; I2: 0%). When large cohort studies were included in the analysis, an increased risk of AMI among men who had ADT was found ( OR 2.01, 95% CI:1.90 – 2.13; I2: 91.3%). Conclusions: ADT in prostate cancer patients for at least 6 months is not associated with cardiovascular mortality, acute myocardial infarct and stroke. However, patients receiving ADT had a significant increase in nonfatal cardiovascular events.

Is Androgen Deprivation Therapy for Prostate Cancer Associated with Cardiovascular disease ? A Meta-Analysis and systematic review.

“…Several meta-analysis have focused on ADT related cardiovascular mortality and morbility through processing data from trials with different primary end points [15,16]. However, investigators were not able to stratify the outcome by different kinds of ADT.…”

Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer.

“…For patients who will be treated by prostatectomy or radiation therapy, the biopsy Gleason score is considered a key point in most nomograms for determining the indication of extended lymphadenectomy and changes in the irradiation field or the time of hormone therapy in patients under radiation therapy, thus changing the impact on the morbidity (10)(11)(12)(13)(14).…”

Testing The Efficacy of a Couple-Focused, Tailored eHealth Intervention for Symptom Self-Management Among Men with Prostate Cancer and Their Partners: The Study Protocol

“…With an approximately 97.5% 5-year relative survival rate and median age of 66 at diagnosis,(11) men with localized prostate cancer are likely to survive for many years and die from other illnesses. (12)(13)(14)(15) [Note: Five-year relative survival rates describe the percentage of patients with a disease alive ve years after the disease is diagnosed, divided by the percentage of the general population of corresponding sex and age alive after ve years]. Psychosocial behavioral self-management strategies (e.g., healthy diet and physical activities) are effective for reducing general symptoms,(16, 17) decreasing overall and cancer-speci c mortality,(18-20) and improving QOL among aging populations (including cancer patients).…”