(UroToday.com) The 37th Annual European Association of Urology Congress held in Amsterdam, Netherlands between July 1st,and 4th 2022 was host to an abstract session regarding improvements in metastatic prostate cancer with a focus on imaging and treatment. Ms. Lin presented the results of a nationwide, population-based cohort analysis exploring the association between cardiovascular disease (CVD) risk, gonadotropin releasing hormone agonists (GnRH) and prostate cancer (PCa) diagnosis in men with Type 2 diabetes mellitus (T2DM).
Ms. Lin began her presentation by noting that GnRH agonist use in patients with PCa has been shown to increase risk of CVD. T2DM has also been well-established as a risk factor for CVD. As such, GnRH agonists need to be used with caution in PCa patients with pre-existing T2DM. However, to date no studies have determined an explicit threshold duration of GnRH after which the incidence of CVD would increase significantly. As such, the objective of this study was to quantify the association between PCa, use of GnRH, and CVD risk specifically in men with T2DM.
The study cohorts were created by linking the National Diabetes Register (used to identify men with T2DM) and the Prostate Cancer data Base Sweden 4.1 (to identify men with PCa). The study period was 2006 to 2017. To independently evaluate the association between each of PCa and PCa+ GnRH exposures with risk of subsequent CVD, two cohorts were created:
- PCa cohort (5,714 PCa men vs. 28,445 PCa-free men)
- PCa + GnRH cohort (692 PCa men + GnRH versus 3,460 PCa men without GnRH)
The two groups in each cohort were balanced for baseline characteristics: age, education level, civil status, comorbidities, smoking habits, BMI, physical activity, blood pressure and lipid level statuses. All patients had T2DM.
The outcomes were 10% and 5% increase in 5-year CVD risk score. The CVD risk was estimated by the CVD risk model which was generated by a group of Swedish researchers based on the NDR including 12 predictors: age, diabetes duration, type of hypoglycaemic treatment, HbA1c, blood pressure, total cholesterol, weight, height, smoking and a history of CVD.
On Kaplan-Meier analysis, GnRH exposure was associated with increased 5-year CVD risk (higher in PCa + GnRH versus PCa without GnRH and no PCa, respectively). Notably, the increased 5-year CVD risk score was more likely to occur in men receiving GnRH for more than 1 year.
On multivariable analysis, GnRH exposure was associated with a 26% increased hazard of experiencing CVD (5-year risk increase by 10%: HR 1.26; 5-year risk increase by 5%: HR 1.13). Interestingly, patients with regional or distant metastases had a significantly increased risk of CVD by 10% at 5 years (HRs 1.24 and 1.25, respectively).
Ms. Lin concluded her talk as follows:
- GnRH exposure for greater than one year in men with PCa and pre-existing T2DM was associated with increased CVD risk compared with men with PCa and T2DM, but not on GnRH
- These findings highlight the need to closely monitor CVD risk factors in men with T2DM and PCa starting GnRH, especially in those men receiving GnRH for more than one year
Presented by: Ms. E. Lin, King's College London, Translational Oncology and Urology Research (TOUR) Team, London, United Kingdom
Written by: Rashid Sayyid, MD, MSc – Society of Urologic Oncology (SUO) Clinical Fellow at The University of Toronto, @rksayyid on Twitter during the 2022 European Association of Urology (EAU) Annual Hybrid Meeting, Amsterdam, NL, Fri, July 1 – Mon, July 4, 2022.