title: Coronary artery revascularization and the risk of death in men with prostate cancer.
abstract: OBJECTIVE
  We investigated whether the decrease in death from cardiovascular disease, a major competing risk, explains the observed increase in prostate cancer specific mortality before 1992.
  
  
  METHODS
  Between 1991 and 2006, 1,880 men with known cardiovascular disease underwent radiation therapy for prostate cancer and were followed until July 2008. Cox regression multivariable analysis was performed to assess whether known prostate cancer prognostic factors, history of coronary artery revascularization for cardiovascular disease, age, Charlson comorbidity score and prostate cancer treatment were associated with the risk of death.
  
  
  RESULTS
  Despite a significantly higher Charlson comorbidity score (p<0.001) due to a higher rate of prior myocardial infarction, the risk of death was significantly lower (adjusted hazard ratio 0.63, 95% CI 0.49-0.82, p<0.001) in men who underwent revascularization. High grade prostate cancer contributed significantly to the risk of death in men who underwent revascularization (AHR 1.74, 95% CI 1.04-2.91, p=0.04) but not in those who did not (AHR 1.18, 95% CI 0.88-1.58, p=0.27).
  
  
  CONCLUSIONS
  The availability of and appropriate selection for revascularization may explain the increase in prostate cancer specific mortality before 1992. Men with cardiovascular disease in whom revascularization was not appropriate could consider active surveillance of prostate cancer because the increased risk of death was not associated with high grade prostate cancer.
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, Dana Farber Cancer Institute, and Harvard Medical School, Boston, Massachusetts 02115, USA. adamico@partners.org
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.forename: Daniel
authors.initials: D
authors.lastname: Dosoretz
authors.forename: Michael
authors.initials: M
authors.lastname: Katin
authors.forename: Sharon
authors.initials: S
authors.lastname: Salenius
authors.forename: Rudi
authors.initials: R
authors.lastname: Ross
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications* / Q000601:surgery*; D002423:Cause of Death; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000150:complications* / Q000401:mortality* / Q000532:radiotherapy; D012307:Risk Factors