ORLANDO — Men aged 65 years or older who received androgen deprivation therapy for localized prostate cancer had an increased risk of cardiovascular death, according to a registry review presented at a symposium on prostate cancer sponsored by the American Society of Clinical Oncology.
Older men who received androgen deprivation therapy had a 3% risk of dying from cardiac causes at 5 years, significantly higher than the 0.9% risk in similarly aged men who did not receive hormone therapy, reported Dr. Henry K. Tsai, of Harvard Medical School, Boston. Androgen deprivation therapy was not associated with a significant increase in the risk of death from cardiac causes in men younger than 65 (1.5% for men on androgen treatment, and 0.3% for men not receiving androgen therapy, he said at the symposium, cosponsored by the Society of Urologic Oncology and the American Society for Therapeutic Radiology and Oncology.
Androgen deprivation therapy, which is commonly used to treat men with prostate cancer, causes weight gain, thus predisposing men to diabetes and the metabolic syndrome. Dr. Tsai and his colleagues at Harvard reviewed data from the CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) database to determine whether the use and duration of this treatment might be linked to a fatal cardiac event. They identified 3,636 men with localized prostate cancer who were treated with surgery, external beam radiotherapy, brachytherapy, or cryotherapy. Of these, 735 received androgen deprivation therapy and 2,901 did not.
The investigators analyzed the cardiac mortality and all-cause mortality, controlling for age and other cardiac risk factors including hypertension, diabetes, body mass index, and smoking.
The median age of the subjects was 64 years at baseline, median duration of hormone therapy in the men who received it was 4.1 months, and median duration of follow-up was 4 years.
Overall, men treated with androgen deprivation therapy had a 2.5% risk of cardiac death at 5 years, compared with 0.6% in men who did not get hormones. That difference was statistically significant, but when the data were analyzed separately for men younger than age 65 and men aged 65 or older, a significant difference in risk was seen only in the older men, Dr. Tsai said.
Limitations of this study included an inability to control for hypercholesterolemia and other coronary artery disease risk factors, as well as the retrospective nature of the analysis.
Nevertheless, the findings point to the importance of a cardiovascular evaluation in men with prostate cancer who are being considered for androgen deprivation therapy. They also underscore the importance of monitoring cardiovascular risk factors in such patients. Further prospective evaluations are needed to corroborate these findings, he added.
Men treated with androgen deprivation therapy had a 2.5% risk of cardiac death at 5 years. DR. TSAI