title: Cardiovascular comorbidity and mortality in men with prostate cancer treated with brachytherapy-based radiation with or without hormonal therapy.
abstract: OBJECTIVE
  To assess the impact of coronary artery disease (CAD) risk factors and sequelae on the risk of all-cause mortality (ACM) in men treated for prostate cancer (PC).
  
  
  METHODS
  The study cohort comprised 5077 men with PC consecutively treated with curative intent between 1997 and 2006 at the Chicago Prostate Cancer Center. Cox and Fine and Gray's competing risks regression multivariable analyses were performed, assessing whether cardiovascular comorbidity impacted the risk of ACM and PC-specific mortality, respectively, adjusting for CAD risk factors (diabetes mellitus, hypercholesterolemia, or hypertension) and sequelae (congestive heart failure or myocardial infarction), age, year and type of treatment, and known PC prognostic factors.
  
  
  RESULTS
  When compared with men with no comorbidity there was a significantly increased risk of ACM in men with congestive heart failure or myocardial infarction (adjusted hazard ratio [AHR] 1.96, P<.001) and in men with diabetes mellitus (AHR 1.60, P=.03) and hypertension (AHR 1.25, P=.04). In contrast, men with hypercholesterolemia had a similar risk of ACM (AHR 0.68, P=.17) when compared with men with no comorbidity. Other factors associated with a significantly increased risk of ACM included age (AHR 1.09, P<.001), prostate-specific antigen level (AHR 1.25, P=.008), and Gleason score 8-10 disease (AHR 1.71, P=.003). Cardiovascular comorbidity did not impact the risk of PC-specific mortality.
  
  
  CONCLUSIONS
  In addition to age and unfavorable PC prognostic factors, select CAD risk factors and sequelae are associated with an increased risk of ACM in men treated for PC. These comorbidity prognostic factors predict time courses of mortality from competing causes, which may be factored into the decision-making process when considering management options for PC in a given individual.
authors: Department of Radiation Oncology, MD Anderson Cancer Center Orlando, Orlando, Florida, USA. akash.nanda@orlandohealth.com
authors: Akash
authors: A
authors: Nanda
authors: Ming-Hui
authors: MH
authors: Chen
authors: Brian J
authors: BJ
authors: Moran
authors: Michelle H
authors: MH
authors: Braccioforte
authors: Anthony V
authors: AV
authors: D'Amico
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000209:etiology* / Q000401:mortality; D003920:Diabetes Mellitus; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D060787:Neoplasm Grading; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy*; D012307:Risk Factors
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017430:Prostate-Specific Antigen