(UroToday.com) The 2022 ASTRO annual meeting featured a prostate cancer session, including a presentation by Dr. Abdenour Nabid discussing cardiovascular causes of death in patients treated for localized prostate cancer. From two trials in localized prostate cancer, cardiovascular disease represented the second cause of death. Based on Dr. Nabid and colleagues’ data, they retrieved and reviewed the clinical information on those patients labelled by investigators as dying from cardiovascular disease aiming to confirm and precisely define the cause/diagnosis of their cardiovascular death.
From October 2000 to September 2010, 1,230 patients were randomized into two prostate cancer trials. Causes of death compiled up to January 2022, were based on data from clinical records, death certificates, obituaries, family members, and family physicians. Patients who were reported dying from cardiovascular disease were classified into 2 groups: cardiac events proper and vascular events outside the heart.
The median age was 71 years at randomization and 82 years at least follow-up without a significant difference between high-risk and intermediate risk prostate cancer. With a median follow up of 13.4 years, 663/1230 (53.9%) patients had died, 274 in intermediate-risk prostate cancer and 389 in high-risk prostate cancer. There were 6 of the 136 patients reported as dead from cardiovascular disease that were excluded: 3 pulmonary embolisms, 1 thrombosis, 1 severe veno-occlusive disease and 1 aorto-thoracic dissection. Overall, a total of 130/1230 (10.6%) patients died from cardiovascular disease, accounting for 19.6% (130/663) of all deaths:
There were no significant differences seen in the group of cardiac events proper [47/274 (17.2%) vs 56/389 (14.4%), p = 0.40], or in vascular events outside the heart [15/274 (5.5%) vs 12/389 (3.1%), p = 0.20] between intermediate-risk prostate cancer and high-risk prostate cancer patients, respectively. The group of cardiovascular disease deaths from cardiac events accounted for 79.2% (103/130) of all deaths. Many different diagnoses were attributed as potential cause of cardiac death: coronary heart disease was the most frequent (70.8%), followed by heart rhythm disorders (5.4%), and heart valve disease (3.1%). The second group of cardiovascular disease deaths made of vascular events outside the heart represented 20.8% (27/130) of all cardiovascular disease deaths:
Dr. Nabid concluded this presentation discussing cardiovascular causes of death in patients treated for localized prostate cancer with the following concluding messages:
- In localized prostate cancer, deaths from cardiovascular disease represented almost 20% of all causes of death as per original definition from investigators
- Of these, deaths linked to a truly cardiac event occurred in 79.2% of the cohort with the remaining deaths attributed to vascular events outside the heart
- Notwithstanding potential caveats related to the retrospective nature of this review, this differentiation seems appropriate and may aid in better assessing the possible relationship between ADT and its real impact on the heart
Presented by: Abdenour Nabid, MD, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada
Co-Authors: N. Carrier1, E. Vigneault2, M. A. Brassard3, B. Bahoric4, R. Archambault5, P. Vavassis6, F. Vincent7, R. Bettahar8, D. R. Wilke9, T. V. Nguyen10, A. G. Martin11, J. P. Bahary12, M. Duclos13, S. T. Vass Jr14, and L. Souhami15; 1Centre hospitalier universitaire de Sherbrooke, Sherbrooke, QC, Canada, 2CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ), Québec, QC, Canada, 3CIUSSS du Saguenay-Lac-Saint-Jean, Chicoutimi, QC, Canada, 4Jewish General Hospital, Montreal, QC, Canada, 5CSSSG, Gatineau, QC, Canada, 6Maisonneuve-Rosemont Hospital, Montreal, QC, Canada, 7Centre hospitalier regional de Trois-Rivieres, Trois-Rivieres, QC, Canada, 8CSSS Rimouski-Neigette, Rimouski, QC, Canada, 9Nova Scotia Cancer Centre, Halifax, NS, Canada, 10Centre hospitalier universitaire de Montréal, Montréal, QC, Canada, 11Department of Radiation Oncology CHU de Québec-Université Laval, Québec, QC, Canada, 12Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada, 13McGill University Health Centre, Montreal, QC, Canada, 14CSSS Chicoutimi, Chicoutimi, QC, Canada, 15Department of Radiation Oncology, McGill University Health Centre, Montreal, QC, Canada
Written by: Zachary Klaassen, MD, MSc – Urologic Oncologist, Assistant Professor of Urology, Georgia Cancer Center, Augusta University/Medical College of Georgia, @zklaassen_md on Twitter during the 2022 American Society of Radiation Oncology (ASTRO) Annual Hybrid Meeting, San Antonio, TX, Sat, Oct 22 – Wed, Oct 26, 2022.