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Androgen Deprivation Therapy for Prostate Cancer and the Risk of Autoimmune Diseases - Beyond the Abstract

Androgen deprivation therapy (ADT) has been a mainstay treatment for advanced prostate cancer for more than 60 years. To achieve serum testosterone at castration level for slowing prostate cancer progression is the main purpose of ADT. Meanwhile, sex hormones including androgens and estrogens may regulate some part of human immunity. There are limited studies to investigate the immune effects of the castration achieved by ADT.

In this retrospective study of 17,168 newly diagnosed prostate cancer were selected from the Taiwan National Health Insurance Research Database. Finally, there were 5,590 patients with ADT and 5,590 non-ADT patients were included in the study cohort with a median follow-up period of 3.82 years. A propensity score-matched analysis showed a significantly decreased 38% risk of autoimmune diseases in patients with ADT comparing with non-ADT patients. A significant decrease in the risk of autoimmune diseases with increasing duration of ADT use was also noted.

Yang et al. reported a 23% increased risk of rheumatoid arthritis in 44,785 patients who received ADT for prostate cancer in North America.1 It seems to exist some disparity with our study. Further studies are needed to have a better understanding of ADT and autoimmune diseases.

We provide a hint of ADT in the modification of inflammation and autoimmunity in Asian patients with prostate cancer. Physicians may take this phenomenon into consideration.

Written by:
Jui-Ming Liu1,2,3 , Chun-Te Wu4 ,Ren-Jun Hsu3,5,6
1. Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
2. Department of Medicine, National Yang-Ming University, Taipei, Taiwan
3. Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
4. Department of Urology, Chang Gung Memorial Hospital, Keelung, Taiwan
5. Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
6. Cancer Medicine Center of Hualien Tzu Chi Hospital, Tzu Chi University, Hualien, Taiwan


Reference
1. Yang DD, Krasnova A, Nead KT, Choueiri TK,, et al. Androgen deprivation therapy and risk of rheumatoid arthritis in patients with localized prostate cancer. Ann Oncol. 2018;29:386–91.

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