Trends in Androgen Deprivation Use in Men With Intermediate-Risk Prostate Cancer Who Underwent Radiation Therapy

Agrawal, Vishesh; Ma, Xiaoyue; Hu, Jim C.; Barbieri, Christopher E.; Nagar, Himanshu

doi:10.1016/j.adro.2022.100904

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…It was possible that similar changes in the selection of patients for ADT have influenced the cardiovascular outcomes. This was especially relevant since the use of ADT is heavily dependent on patient preferences even within guidelines [ 3 , 22 ], with studies having shown significant variations in practice [ 23 , 24 ]. It may thus be reasonable to speculate that changes in patient preferences outside the scope of this study may have contributed to the differences in cardiovascular burden and outcomes, either directly or by influencing patient selection for ADT.…”

Section: Discussionmentioning

confidence: 99%

Temporal trends in cardiovascular burden among patients with prostate cancer receiving androgen deprivation therapy: a population-based cohort study

Chan¹,

Satti²,

Lee

et al. 2023

Br J Cancer

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Background Although androgen deprivation therapy (ADT) is associated with cardiovascular risks, the extent and temporal trends of cardiovascular burden amongst patients with prostate cancer receiving ADT are unclear. Methods This retrospective cohort study analyzed adults with PCa receiving ADT between 1993–2021 in Hong Kong, with follow-up until 31/9/2021 for the primary outcome of major adverse cardiovascular events (MACE; composite of cardiovascular mortality, myocardial infarction, stroke, and heart failure), and the secondary outcome of mortality. Patients were stratified into four groups by the year of ADT initiation for comparisons. Results Altogether, 13,537 patients were included (mean age 75.5 ± 8.5 years old; mean follow-up 4.7 ± 4.3 years). More recent recipients of ADT had more cardiovascular risk factors and used more cardiovascular or antidiabetic medications. More recent recipients of ADT had higher risk of MACE (most recent (2015–2021) vs least recent (1993–2000) group: hazard ratio 1.33 [1.11, 1.59], P = 0.002; Ptrend < 0.001), but lower risk of mortality (hazard ratio 0.76 [0.70, 0.83], P < 0.001; Ptrend < 0.001). The 5-year risk of MACE and mortality for the most recent group were 22.5% [20.9%, 24.2%] and 52.9% [51.3%, 54.6%], respectively. Conclusions Cardiovascular risk factors were increasingly prevalent amongst patients with prostate cancer receiving ADT, with increasing risk of MACE despite decreasing mortality.

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Section: Discussionmentioning

confidence: 99%

Temporal trends in cardiovascular burden among patients with prostate cancer receiving androgen deprivation therapy: a population-based cohort study

Chan¹,

Satti²,

Lee

et al. 2023

Br J Cancer

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“…The median age of men who receive ADT is 68–69 years old, 18 with ADT increasingly prescribed for longer durations (≥24 months) based on evidence of improved disease‐free status and overall survival even in higher risk PCa 19 . This highlights the importance of understanding interactions of long‐term ADT with age‐related cognitive decline that is most pronounced at or after age 65.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 As a result, the use of ADT in PCa has been investigated for its effects on cognition and the brain, showing relationships with lower cognitive performance, higher risk of dementia, 13 as well as reductions in gray matter volume, 14 white matter integrity, 15 and compensatory restingstate functional activity. 16,17 The median age of men who receive ADT is 68-69 years old, 18 with ADT increasingly prescribed for longer durations (≥24 months) based on evidence of improved disease-free status and overall survival even in higher risk PCa. 19 This highlights the importance of understanding interactions of long-term ADT with age-related cognitive decline that is most pronounced at or after age 65.…”

Section: Introductionmentioning

confidence: 99%

Cognitive effects of long‐term androgen deprivation therapy in older men with prostate cancer

Pergolizzi,

Flaherty,

Saracino

et al. 2024

Psycho-Oncology

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ObjectiveAndrogen deprivation therapy (ADT) is a common treatment for prostate cancer (PCa), with increasing numbers of men on ADT for longer. Limited evidence suggests ADT impacts cognition. This study addressed gaps in the literature by focusing on older men with PCa and assessing ADT usage longer than 1 year.MethodsThis study of 133 men ≥65 years of age with PCa included two groups: (1) men on ADT for 1–3 years (ADT‐exposed), and (2) a comparison group of men with PCa not on ADT (ADT‐unexposed). Group comparisons on individual neuropsychological test scores are reported, as well as effect sizes (Cohen's d).ResultsHalf (n = 67) of the sample was ADT‐exposed and half (n = 66) were unexposed. The average age was 72 years, most were White, and over 50% had at least secondary education. There were no statistically significant differences between groups by age, race, or education. Unadjusted analyses showed the ADT‐exposed group, compared with the ADT‐unexposed group, performed significantly lower in domains of verbal learning (d = 0.45–0.52, p = 0.01 to <0.01), verbal recall (d = 0.33–0.54, p = 0.06 to <0.01), and possible effects in visuospatial construction (d = 0.33, p = 0.08 to 0.06). When controlling for age and education, similar patterns emerged. The ADT exposed‐group performed significantly lower in domains of verbal learning (d = 0.45–0.52, p = 0.06 to 0.03) and verbal recall (d = 0.33–0.54, p = 0.11 to 0.03), and possible effects in visuospatial construction d = 0.33, p = 0.18 to 0.13.ConclusionsThis study suggests long‐term ADT exposure impacts verbal learning, verbal recall, and possibly visuospatial abilities in older men (≥65) with PCa. The potential cognitive effects of ADT should be discussed with older patients considering long‐term use of ADT.

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“…However, the benefit may vary for individuals within each risk group, and treatment decisions require understanding the patient's individual risks, goals, preferences, and willingness to undergo various therapies. For example, only 53% of patients with unfavorable intermediate-risk prostate cancer who received RT between 2004 and 2016 added ADT, 20 although randomized trial data showed improved outcomes as early as 2002. 21 An accurate prognostic estimate of the baseline risk is necessary to determine an individual's ARR.…”

Section: Introductionmentioning

confidence: 99%

Using the Cell-Cycle Risk Score to Predict the Benefit of Androgen-Deprivation Therapy Added to Radiation Therapy in Patients With Newly Diagnosed Prostate Cancer

Tward,

Lenz,

Gutin

et al. 2024

JCO Precis Oncol

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PURPOSE Guidelines recommend adding androgen-deprivation therapy (ADT) to radiation therapy (RT) in certain patients with localized prostate cancer. Individualized genomic testing may improve the prognostic accuracy of risk assessments. Herein, we describe a mathematical model of the benefit of adding ADT to RT as a function of the personalized clinical cell-cycle risk (CCR) score to inform 10-year metastasis risk. METHODS A model of absolute risk reduction (ARR) was built using a retrospective cohort of men tested with Prolaris who received RT alone (N = 467). The relative benefit of ADT added to RT to reduce distant metastasis was estimated at 41% on the basis of a meta-analysis of randomized trials. The ARR and number needed to treat (NNT) were computationally derived in patients clinically tested with Prolaris between January 1, 2020, and October 31, 2022 (N = 56,485). Risks were predicted using a cause-specific Cox proportional hazards model with CCR score predicting time to metastasis. A CCR score of 2.112 represents the validated multimodal treatment (MMT) threshold. RESULTS The ARR from ADT increased from almost zero at low CCR scores to 17.1% at CCR = 3.690 with the corresponding NNT = 6, indicating that adding ADT to RT would prevent metastasis within 10 years for one of every six treated individuals. In the clinical cohort, the average ARR was 0.86% in individuals under the MMT threshold (NNT = 116). The average ARR was 8.19% in individuals above the MMT threshold (NNT = 12). Broad ranges of ADT benefit were observed within National Comprehensive Cancer Network risk categories. CONCLUSION The precise and personalized risk estimate of metastasis provided by the CCR score can help inform patients and physicians when considering treatment intensification.

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Trends in Androgen Deprivation Use in Men With Intermediate-Risk Prostate Cancer Who Underwent Radiation Therapy

Cited by 5 publications

References 28 publications

Temporal trends in cardiovascular burden among patients with prostate cancer receiving androgen deprivation therapy: a population-based cohort study

Temporal trends in cardiovascular burden among patients with prostate cancer receiving androgen deprivation therapy: a population-based cohort study

Cognitive effects of long‐term androgen deprivation therapy in older men with prostate cancer

Using the Cell-Cycle Risk Score to Predict the Benefit of Androgen-Deprivation Therapy Added to Radiation Therapy in Patients With Newly Diagnosed Prostate Cancer

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