ADT identified as independent risk factor for fatal CVD events

Androgen deprivation therapy (ADT) delivered in conjunction with surgery, radiation therapy, or cryotherapy for localized prostate cancer appears to significantly increase the risk of fatal cardiovascular (CVD) events among men 65 years and older. The increased risk is maintained after adjusting for most known coronary artery disease (CAD) risk factors and increases with increasing duration of therapy, but is present in men receiving as little as 3 months of ADT, according to the findings of a retrospective study reported yesterday at the AUA annual meeting.

Using the CaPSURE prostate cancer disease registry, researchers identified 3,636 men who were treated for localized prostate cancer and had information available on baseline CAD risk factors; 735 of those men received ADT (median duration, 4 months). During a median follow-up of 4 years, 27 men died of cardiac causes.

In statistical analyses using methodology to account for competing causes of death and controlling for other CAD risk factors, the estimated 5-year rate of fatal CVD events was significantly higher in ADT-treated men compared to those who were untreated (2.5% vs. 0.6%; pp=.004), reported lead author Anthony V. D'Amico, MD, Harvard Medical School, Boston.

"Although the increased risk in the older men may seem small, it is not inconsequential considering the endpoint is CVD events leading to death," Dr. D'Amico said. "Based on these results, we believe that an older prostate cancer patient with any known CAD risk factors who is being considered for long-term hormone therapy should first be referred for evaluation by a cardiologist. This investigation seems warranted to make sure that our treatment does not do more harm than good."

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