Androgen deprivation therapy and cardiovascular risk

Sanoj Punnen, Matthew R. Cooperberg, Natalia Sadetsky, Peter R. Carroll

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Purpose: The potential association between androgen deprivation therapy (ADT) and cardiovascular mortality (CVM) remains controversial. This study assessed mortality outcomes in a large national registry to further elucidate the association between treatment selection and cause of mortality. Patients and Methods: A total of 7,248 men in the CaPSURE registry were analyzed. Treatment was categorized as local only, primary ADT monotherapy, local treatment plus ADT, and watchful waiting/active surveillance (WW/AS). Competing hazards survival analysis was performed for prostate cancer-specific mortality (PCSM), CVM, and all-cause mortality. A propensity score-adjusted and a propensity-matched analysis were undertaken to adjust for imbalances in covariates among men receiving various treatments. Results: Patients treated with ADT or WW/AS had a higher likelihood of PCSM than those treated with local therapy alone. Patients treated with primary ADT had an almost two-fold greater likelihood of CVM (HR, 1.94; 95% CI, 1.29 to 2.97) than those treated with local therapy alone; however, patients treated with WW/AS had a greater than two-fold increased risk of CVM (HR, 2.46; 95% CI, 1.53 to 3.95). A propensity-matching algorithm in a subset of 1,391 patients was unable to find a significant difference in CVM between those who did or did not receive ADT. Conclusion: Patients matched on propensity to receive ADT did not show an association between ADT and CVM. This suggests that potential unmeasured variables affecting treatment selection may confound the relationship between ADT use and cardiovascular risk. However, an association may yet exist, because the propensity score could not include all known risk factors for CVM.

Original languageEnglish (US)
Pages (from-to)3510-3516
Number of pages7
JournalJournal of Clinical Oncology
Volume29
Issue number26
DOIs
StatePublished - Sep 10 2011
Externally publishedYes

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Androgens
Mortality
Watchful Waiting
Therapeutics
Propensity Score
Registries
Prostatic Neoplasms
Survival Analysis

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Androgen deprivation therapy and cardiovascular risk. / Punnen, Sanoj; Cooperberg, Matthew R.; Sadetsky, Natalia; Carroll, Peter R.

In: Journal of Clinical Oncology, Vol. 29, No. 26, 10.09.2011, p. 3510-3516.

Research output: Contribution to journalArticle

Punnen, S, Cooperberg, MR, Sadetsky, N & Carroll, PR 2011, 'Androgen deprivation therapy and cardiovascular risk', Journal of Clinical Oncology, vol. 29, no. 26, pp. 3510-3516. https://doi.org/10.1200/JCO.2011.35.1494
Punnen, Sanoj ; Cooperberg, Matthew R. ; Sadetsky, Natalia ; Carroll, Peter R. / Androgen deprivation therapy and cardiovascular risk. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 26. pp. 3510-3516.
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