Objectives: To determine if androgen-deprivation therapy (ADT) is associated with excess cardiac-specific mortality (CSM) in men with prostate cancer and no cardiovascular comorbidity, coronary artery disease risk factors, or congestive heart failure (CHF) or past myocardial infarction (MI).
Patients And Methods: In all, 5077 men (median age 69.5 years) with cT1c-T3N0M0 prostate cancer were treated with brachytherapy with or without neoadjuvant ADT (median duration 4 months) between 1997 and 2006. Fine and Gray competing risks analysis evaluated the association of ADT with CSM, adjusting for age, year of brachytherapy, and ADT treatment propensity score among men in groups defined by cardiac comorbidity.
Results: After a median follow-up of 4.8 years, no association was detected between ADT and CSM in men with no cardiac risk factors (1.08% at 5 years for ADT vs 1.27% at 5 years for no ADT, adjusted hazard ratio (AHR) 0.83; 95% confidence interval (CI), 0.39-1.78; P = 0.64; n = 2653) or in men with diabetes mellitus, hypertension, or hypercholesterolaemia (2.09% vs 1.97%, AHR 1.33; 95% CI 0.70-2.53; P = 0.39; n = 2168). However, ADT was associated with significantly increased CSM in men with CHF or MI (AHR 3.28; 95% CI 1.01-10.64; P = 0.048; n = 256). In this subgroup, the 5-year cumulative incidence of CSM was 7.01% (95% CI 2.82-13.82%) for ADT vs 2.01% (95% CI 0.38-6.45%) for no ADT.
Conclusion: ADT was associated with a 5% absolute excess risk of CSM at 5 years in men with CHF or prior MI, suggesting that administering ADT to 20 men in this potentially vulnerable subgroup could result in one cardiac death.
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http://dx.doi.org/10.1111/bju.12905 | DOI Listing |
BMJ Evid Based Med
December 2024
Department of Public Health, History of Science, and Gynecology, Miguel Hernandez University of Elche Faculty of Medicine, Sant Joan D'Alacant, Comunidad Valenciana, Spain
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January 2025
Department of Emergency Medicine, Henry Ford Health, Detroit, MI 48202, USA.
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View Article and Find Full Text PDFJ Clin Med
December 2024
Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, 37126 Verona, Italy.
Prostate cancer (PCa) is prevalent among men over 70. Treatment may involve interventions like radical prostatectomy. The objective of this study was to investigate the combination of adverse pathology patterns on PCa progression through the Briganti 2012 nomogram and EAU risk classes in elderly patients treated with robotic surgery.
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Department of Urology, Health Science University Eskisehir City Health Application and Research Center, 26080 Eskisehir, Turkey.
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January 2025
Department of Hematology-Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Oligometastatic prostate cancer (OMPC) represents an intermediate state in the progression from localized disease to widespread metastasis when the radiographically significant sites are limited in number and location. With no clear consensus on a definition, its diagnostic significance and associated optimal therapeutic approach remain controversial, posing a significant challenge for clinicians. The current standard of care for metastatic disease is to start systemic therapy; however, active surveillance and targeted radiotherapy have become attractive options to mitigate the long-term effects of androgen deprivation therapy (ADT).
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