OBJECTIVE: To examine and quantify the contemporary association between ADT and three separate endpoints: coronary artery disease (CAD), acute myocardial infarction (AMI), and sudden cardiac death (SCD), in a large United States contemporary cohort of PCa patients.
MATERIALS AND METHODS: Overall, 140,474 patients diagnosed with non-metastatic PCa between 1995 and 2009 within the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database were abstracted. Patients treated with ADT and those not receiving ADT were matched using propensity-score methodology. Ten-year CAD, AMI, and SCD rates were estimated. Competing-risks regression analyses tested the association between the type of ADT (GnRH agonists vs. bilateral orchiectomy) and CAD, AMI, and SCD, after adjusting for the risk of dying during follow-up.
RESULTS: Overall, the 10-year rates of CAD, AMI, and SCD were 25.9, 15.6, and 15.8%, respectively. After stratification according to ADT status (ADT-naïve vs. GnRH agonists vs. bilateral orchiectomy), the CAD rates were 25.1 vs. 26.9 vs. 23.2%, the AMI rates were 14.8 vs. 16.6 vs. 14.8%, and the SCD rates were 14.2 vs. 17.7 vs. 16.4%, respectively. In competing-risks multivariable regression analyses, the administration of GnRH agonists (all P< 0.001), but not bilateral orchiectomy (all P≥0.7), was associated with higher risk of CAD, AMI, and SCD.
CONCLUSIONS: The administration of GnRH agonists, but not orchiectomy, is still associated with a significantly increased risk of CAD, AMI, and, especially, SCD in patients with non-metastatic PCa. Alternative forms of ADT should be considered in patients at higher risk of CV events.
Written by:
Gandaglia G, Sun M, Popa I, Schiffmann J, Abdollah F, Trinh QD, Saad F, Graefen M, Briganti A, Montorsi F, Karakiewicz PI. Are you the author?
Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Canada; Urological Research Institute, Vita-Salute San Raffaele University, San Raffaele Hospital, San Raffaele Scientific Institute, Milan, Italy.
Reference: BJU Int. 2014 Mar 10. Epub ahead of print.
doi: 10.1111/bju.12732
PubMed Abstract
PMID: 24612110
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