Risk of thromboembolic disease in men with prostate cancer undergoing androgen deprivation therapy

Abstract

ObjectivesTo investigate the risk of thromboembolic disease (TED) in men with prostate cancer (PCa) on androgen deprivation therapy (ADT), while accounting for known TED risk factors. Materials and MethodsWe assessed TED risk for 42 263 men with PCa who were receiving ADT compared with a matched cohort of 190 930 without PCa. The associations between ADT and deep vein thrombosis (DVT) or pulmonary embolism (PE) were analysed using multivariate Cox proportional hazard regression models, while accounting for previous PCa-related surgeries and the following proxies for disease progression: transurethral resection of the prostate, palliative radiotherapy and nephrostomy. ResultsBetween 1997 and 2013, 11 242 men with PCa received antiandrogen monotherapy, 26 959 men received gonadotropinreleasing hormone (GnRH) agonists, 1 091 men received combined androgen blockade and 3 789 men underwent orchiectomy. When accounting for previous surgeries and proxies of disease progression, GnRH agonist users and surgically castrated men had a higher risk of TED than the comparison cohort: hazard ratios (HRs) 1.67 (95% confidence interval [CI] 1.40-1.98) and 1.61 (95% CI 1.15-2.28), respectively. Men on anti-androgen monotherapy had a lower risk: HR for DVT 0.49 (95% CI 0.33-0.74). TED risk was highest among those who switched from anti-androgen to GnRH agonists: HR for PE 2.55 (95% CI 1.76-3.70). This increased from 2.52 (95% CI 1.54-4.12) in year 1, to 4.05 (95% CI 2.51-6.55) in year 2. ConclusionThe incidence of TED among men on ADT increased with the duration of therapy and the risk was highest for those who switched regimen, suggesting that disease progression as well as ADT contribute to the propagation of TED risk. Nonetheless, these findings support the hypothesis that only men with a relevant indication should receive systemic ADT.

Association between ischaemic bowel syndromes and androgen deprivation therapy in patients with prostate cancer: a retrospective cohort study

“…O'Farrell et al assessed the risk of thromboembolic disease in patients with PC undergoing ADT. The group noted that the incidence of deep vein thrombosis and pulmonary embolism increases with prolonged ADT usage and recommended that only men with relevant indication should receive systemic ADT 14. The study also showed an increased thrombotic risk in the patients who switched from antiandrogen therapy to GnRH agonist therapy, although these agonists were not considered in our present analysis 14.…”

“…The group noted that the incidence of deep vein thrombosis and pulmonary embolism increases with prolonged ADT usage and recommended that only men with relevant indication should receive systemic ADT 14. The study also showed an increased thrombotic risk in the patients who switched from antiandrogen therapy to GnRH agonist therapy, although these agonists were not considered in our present analysis 14. Teoh et al 31 observed that ADT users presented an increased risk of ischaemic stroke relative to non-ADT users in patients with PC.…”

“…13 O'Farrell et al 14 reported that ADT would increase the risk of thromboembolic disease. Considering that IBS is common in men with cardiovascular and thromboembolic problems, we evaluated whether IBS is also related to ADT.…”

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

“…anti-androgen treatment), and, as in other medical fields, clinically significant concomitant disease presence [14,[205][206][207][208]. The presence of cancer also increases the risk for symptomatic VTE occurrence after upper urinary tract surgeries up to 1-5% [14,179,12,183].…”

Androgen Deprivation Therapies and Changes in Comorbidity: A Comparison of Gonadotropin-releasing Hormone Agonists and Antiandrogen Monotherapy as Primary Therapy in Men with High-risk Prostate Cancer

“…GnRH agonists are also associated with metabolic adverse effects including bone loss with increased risk of fractures [5][6][7] , cardiovascular disease [8][9][10][11][12] , stroke 10,11,13 , thrombolytic events 14 , type 2 diabetes 9,15,16 and dementia 17 . For AA, the most frequently reported adverse events are breast pain and gynaecomastia 18 .…”