Prostate cancer is one of the most prevalent malignancies in the European male population. In the most recent analysis, prostate cancer incidence rates in Lithuania were reported to be the highest globally in the period 2008-201. The high incidence rates of prostate cancer may be a result of the national prostate cancer screening program based on serum prostate-specific antigen (PSA) testing introduced in Lithuania in 2006.
Androgen deprivation therapy ( ADT) is a “core therapy” for patients diagnosed with high-risk, advanced, metastatic, localized prostate cancer. There are several ADT options, such as bilateral orchidectomy, gonadotropin-releasing hormone (GnRH) agonist, and antagonist, with the agonist being the most widely used.
There are many studies on the association between the incidence rate of cardiovascular events and ADT. For example, Keating et al. showed that the use of gonadotropin-releasing hormone agonists increases the risk of coronary heart disease (HR 1.16, 95% CI [1.10–1.21]), myocardial infarction (HR 1.11, 95% CI 95% [1.01–1.21]) and sudden cardiac death (HR 1.16, 95% CI [1.05–1.27]).
The latest study by Cone et al. showed similar results: GnRH agonist use increased the risk of heart failure and myocardial infarction (odds ratio (OR) 2.06 (95% CI [1.76–2.41]) and 1.80 (CI 95% [1.61–2.03]) respectively). On the other hand, the EORTC study reported no statistically significant differences between ADT users and non-users with respect to cardiovascular diseases (CVD).
Prostate malignancies are largely diagnosed in an elderly population. Typically, these men are already diagnosed with CVD. A prominent population-based study from South Korea looking at patients diagnosed with prostate cancer reported dual findings: although there was no correlation between ADT use and the need for cardiovascular intervention after the cardiovascular event, prior CVD significantly increased the risk of intervention cardiovascular in ADT users. Consequently, identification of patients with CVD before ADT therapy plays an essential role in optimizing treatment and decision making for clinicians.
The primary objective of this study was to evaluate the risk of CVD mortality in the national cohort of patients diagnosed with prostate cancer and treated with ADT compared to non-ADT users.
Summary Purpose: The primary purpose of this study was to evaluate the risk of CVD mortality in the national cohort of patients diagnosed with prostate cancer and treated with Androgen Deprivation Therapy (ADT) compared to non-ADT users. Materials and methods: We conducted a retrospective cohort study of patients aged 40 to 79 years and diagnosed with prostate cancer between January 1, 2012 and December 31, 2016 using data from the Lithuanian cancer registry. In total, 13,343 prostate cancer patients were included in the final study cohort who exclusively used gonadotropin-releasing hormone agonists. The primary outcomes recorded during follow-up in this study were overall CVD death. Results : There was a higher risk of death from CVD in the cohort of patients treated with ADT than in non-ADT users (HR 2.14, 95% CI [1.86-2.45], p < 0.001). Additionally, there was an increased risk of death from ischemic heart disease and stroke (HR 1.42, 95% CI [1.16–1.73] and 1.70, 95% CI [1.18–2.45 ], respectively) among ADT users. Finally, the risk of CVD-related mortality was highest in the ADT user age group 70 to 79 years (HR 4.78, 95% CI [3.79 to 6.04]). Conclusions: This study shows that ADT use is associated with an increased risk of CVD-related mortality for patients diagnosed with prostate cancer compared to non-ADT users. The highest risk of mortality was found for ischemic heart disease and stroke. CVD-related mortality also increased in the older patient group. |
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Experts suggest that patients should be screened for pre-existing cardiovascular diseases before commonly applied treatment
Hormone therapy for prostate cancer increases the risk of cardiovascular disease-related death, especially in older men, according to a population-based study involving more than 13,000 patients.
The paper, published today in the peer-reviewed journal The Aging Male , found an elevated risk of death from cardiovascular disease for men with prostate cancer treated with hormone-lowering drugs compared to those who were not.
The highest risk was for coronary heart disease and stroke. The increased risks became evident beginning in the second year after cancer diagnosis and were most pronounced in older men.
“Hormone therapy is often used for patients with prostate cancer, but more research is now needed to gain a better understanding of the overall risks and benefits of this treatment,” says lead author Justinas Jonusas at the National Cancer Institute. Lithuania. “Our results suggest that physicians should consider cardiovascular disease risk reduction and mitigation strategies when developing a treatment plan for men diagnosed with prostate cancer, particularly for older patients.”
Hormone therapy, also known as androgen deprivation therapy, is an essential treatment for patients with prostate cancer. Treatment uses surgery or medications to reduce the levels of hormones (such as testosterone) in the body that fuel cancer growth. While some previous research has suggested that hormone therapy may increase the risk of negative cardiovascular outcomes, other studies have found no such link, leaving the relationship between prostate cancer treatment and cardiovascular disease unclear.
In this study, researchers used data from the Lithuanian cancer registry to identify 13,343 men ages 40 to 79 who were diagnosed with prostate cancer between 2012 and 2016. They compared the risk of death from cardiovascular disease among the 3,797 patients. who had received hormone-lowering medications. drugs and 9,546 that do not. The mean follow-up time for the group that received hormonal treatment was 4.63 years and 5.13 years for those who did not.
After making appropriate adjustments to the data, the researchers found:
- A more than twofold increase in the risk of death from cardiovascular disease in men who had received hormone therapy.
- An increased risk of cardiovascular disease-related death beginning in the second year after a prostate cancer diagnosis.
- An almost five-fold increased risk in the 70 to 79 age group of those who received hormone therapy compared to those who did not receive it.
The team also assessed the risk of death from various subtypes of cardiovascular disease, identifying that there was an increased risk of dying specifically from stroke or coronary heart disease. These risks were 42% and 70% higher, respectively, in men treated with hormone therapy compared to those who did not receive hormone therapy.
“Prostate cancer is usually diagnosed in older men, over the age of 65, and many of them will have already been diagnosed with cardiovascular disease,” says Jonusas. “It is therefore concerning that we found such a tremendous increase in the risk of cardiovascular disease-related death in elderly men receiving hormone-lowering medications. "Consequently, we would like to express our idea that this group of patients should be screened for pre-existing cardiovascular diseases and their risk factors to minimize the risk of dying from these conditions."
This is the first study to examine hormone therapy-induced cardiovascular death in a national cohort, based on real-world data.
