Source: Nobel Committee

The use of androgen deprivation therapy (ADT) appears to be associated with an increased risk of death from cardiovascular causes in patients undergoing radical prostatectomy for localized prostate cancer, according to study results published in the Oct. 17 issue of the Journal of the National Cancer Institute.

Men who had adjuvant or neo-adjuvant androgen deprivation therapy along with surgery had 2.6 times the risk of cardiovascular death as men who had surgery alone, based on the findings of Henry Tsai, MD, a radiation oncologist of Harvard Medical School and colleagues.

The researchers examined a database consisting of 4,892 patients with localized cancer, of whom 3,262 were treated with a prostatectomy and 1,630 who had external beam radiation therapy, brachytherapy or cryotherapy. Of those patients, 1,015 were treated with androgen deprivation therapy, including 266 who had surgery and 749 who were treated non-surgically. The researchers reported that 131 patients in the study group died of cardiovascular causes during a median follow-up of 3.8 years.

A competing risk-regression analysis that controlled for age and cardiovascular risk factors found that:

• ADT among surgical patients was associated with an increased risk of cardiovascular death. The adjusted hazard ratio was 2.6, with a 95 percent confidence interval from 1.4 to 4.7.
• Among surgical patients younger than 65, the five-year cumulative incidence of death from cardiovascular causes was 3.6 percent for patients using ADT and 1.2 percent for the rest.
• Among older surgical patients with and without ADT, the five-year cumulative incidence of death from cardiovascular causes was 5.5 percent and 2 percent, respectively.
• Among both surgical and non-surgical patients, age was associated with an increased risk. The adjusted hazard ratio in both cases was 1.07, with a 95 percent confidence interval from 1.02 to 1.1.

In an editorial, Jerome Seidenfeld, PhD, of the Blue Cross and Blue Shield Association, and colleagues, said the study emphasized the need to make informed prostate cancer therapy choices.