Please use this identifier to cite or link to this item: https://hdl.handle.net/2440/93473
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Type: Journal article
Title: Association of androgen-deprivation therapy with excess cardiac-specific mortality in men with prostate cancer
Author: Ziehr, D.
Chen, M.
Zhang, D.
Braccioforte, M.
Moran, B.
Mahal, B.
Hyatt, A.
Basaria, S.
Beard, C.
Beckman, J.
Choueiri, T.
D'Amico, A.
Hoffman, K.
Hu, J.
Martin, N.
Sweeney, C.
Trinh, Q.
Nguyen, P.
Citation: BJU International, 2015; 116(3):358-365
Publisher: Wiley
Issue Date: 2015
ISSN: 1464-4096
1464-410X
Statement of
Responsibility: 
David R. Ziehr, Ming-Hui Chen, Danjie Zhang, Michelle H. Braccioforte, Brian J. Moran, Brandon A. Mahal, Andrew S. Hyatt, Shehzad S. Basaria, Clair J. Beard, Joshua A. Beckman, Toni K. Choueiri, Anthony V. D'Amico, Karen E. Hoffman, Jim C. Hu, Neil E. Martin, Christopher J. Sweeney, Quoc-Dien Trinh, and Paul L. Nguyen
Abstract: 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.
Keywords: prostate
prostatic neoplasms
antineoplastic agents
goserelin
leuprolide
coronary disease
Rights: © 2014 The Authors BJU International © 2014 BJU International
DOI: 10.1111/bju.12905
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