title: Influence of androgen deprivation therapy on all-cause mortality in men with high-risk prostate cancer and a history of congestive heart failure or myocardial infarction.
abstract: OBJECTIVE
  It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease.
  
  
  METHODS
  Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT.
  
  
  RESULTS
  ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075).
  
  
  CONCLUSIONS
  Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.
authors.affiliation: Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA. pnguyen@LROC.harvard.edu
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Beckman
authors.forename: Clair J
authors.initials: CJ
authors.lastname: Beard
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Dosoretz
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Salenius
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Braccioforte
authors.forename: Philip W
authors.initials: PW
authors.lastname: Kantoff
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Ennis
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D001918:Brachytherapy / Q000379:methods; D002423:Cause of Death; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000401:mortality*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy
chemical_list: D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen