Androgen-suppression therapy for prostate cancer and the risk of death in men with a history of myocardial infarction or stroke.
OBJECTIVE
To examine the effect of short-course androgen-suppression therapy (AST) before brachytherapy on all-cause mortality (ACM) rates, stratified by the presence or absence of a history of myocardial infarction (MI) or stroke. AST is used to reduce prostate size to enable men with favourable-risk prostate cancer to undergo brachytherapy, but no disease-specific benefit has been reported for this practice, and AST use has been associated with an increased risk of ACM in some men with pre-existing cardiovascular disease.


METHODS
The study comprised 12792 men with favourable-risk disease, i.e. a prostate-specific antigen (PSA) level of <20 ng/mL, Gleason score ≤7 and clinical category ≤T2c, treated between 1991 and 2007 at community-based medical centres with brachytherapy ± neoadjuvant AST. Multivariable Cox regression analysis was used to assess whether there were significant associations between AST use in men with a history of MI or stroke and the risk of ACM, adjusting for age, treatment year, and known prognostic factors of prostate cancer.


RESULTS
After a median (interquartile range) follow-up of 3.8 (2.0-5.9) years there were 1557 deaths. The risk of ACM was lower in men with no history of MI or stroke than in those with this history, whether AST was used (adjusted hazard ratio 0.79, 95% confidence interval 0.67-0.92; P= 0.003) or not (0.74, 0.65-0.85; P < 0.001). However, men with a history of MI or stroke treated with AST had a greater risk of ACM than those not treated with AST (1.2, 1.05-1.38; P= 0.008).


CONCLUSIONS
The use of short-course AST in men with a history of MI or stroke is associated with a greater risk of ACM in men with favourable-risk prostate cancer.
Dana-Farber Cancer Institute, Boston, MA 02115, USA. Julia_Hayes@dfci.harvard.edu
Julia H
JH
Hayes
Ming-Hui
MH
Chen
Brian J
BJ
Moran
Michelle H
MH
Braccioforte
Daniel E
DE
Dosoretz
Sharon
S
Salenius
Michael J
MJ
Katin
Rudi
R
Ross
Toni K
TK
Choueiri
Anthony V
AV
D'Amico
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects*; D000728:Androgens / Q000378:metabolism; D001918:Brachytherapy; D002423:Cause of Death; D003131:Combined Modality Therapy; D004812:Epidemiologic Methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000401:mortality; D011471:Prostatic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D020521:Stroke / Q000139:chemically induced* / Q000401:mortality; D016896:Treatment Outcome
D000726:Androgen Antagonists; D000728:Androgens