Anti-androgens increase N-terminal pro-BNP levels in men with prostate cancer.
OBJECTIVE
The aim of this study was to determine the effects of anti-androgens on left ventricular (LV) function and levels of N-terminal proB-type natriuretic peptide (NT-proBNP), a sensitive cardiac risk marker, in men with prostate cancer as these are widely used drugs in this condition, and evidence suggests that endogenous androgens are cardioprotective in men.


METHODS
Forty-three men (mean age 70.7 +/- 6.2 years) with prostate cancer were randomized to goserelin (an LH-releasing hormone analogue) or bicalutamide (an androgen-receptor blocker) for 6 months; 20 men with a history of prostate cancer on no treatment were studied in parallel.


RESULTS
Mean changes in testosterone and oestradiol, respectively, from baseline to 6 months were -88% and -46% with goserelin, +50% and +44% with bicalutamide, and -1% and -9% for the 'no-treatment' group. Bicalutamide significantly increased NT-proBNP from baseline to 3 and 6 months (median value at baseline, 3 and 6 months: 55, 101 and 118 ng/l, respectively). Goserelin caused a significant increase from baseline to 3 months but not to 6 months (median value at baseline, 3 and 6 months: 66, 87 and 72 ng/l, respectively). No significant changes occurred in the 'no-treatment' cohort (median value at baseline 3 and 6 months: 60, 53 and 60 ng/l, respectively). No significant changes in LV function, blood pressure (BP), body mass index or waist-hip ratio occurred to account for the changes in NT-proBNP.


CONCLUSIONS
Androgen receptor blockade and, to a lesser extent, androgen suppression cause an increase in NT-pro-BNP in men with prostate cancer. The significance is not clear but could imply an adverse effect on cardiovascular risk following hormonal manipulation.
Dockery
Frances
F
Department of Medicine for the Elderly, Imperial College, Hammersmith Hospital, London, UK. fdockery@doctors.org.uk
Bulpitt
Christopher J
CJ
Agarwal
Sanjiv
S
Vernon
Clare
C
Nihoyannopoulos
Petros
P
Kemp
Martin
M
Hooper
James
J
Rajkumar
Chakravarthi
C
D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D000813:Anilides / Q000627:therapeutic use*; D004958:Estradiol / Q000097:blood; D017273:Goserelin / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D009570:Nitriles / Q000627:therapeutic use*; D010446:Peptide Fragments / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000188:drug therapy*; D013739:Testosterone / Q000097:blood; D014105:Tosyl Compounds / Q000627:therapeutic use*
D000726:Androgen Antagonists; D000813:Anilides; D009570:Nitriles; D010446:Peptide Fragments; D014105:Tosyl Compounds; C109794:pro-brain natriuretic peptide (1-76); D017273:Goserelin; D020097:Natriuretic Peptide, Brain; D013739:Testosterone; D004958:Estradiol; C053541:bicalutamide