title: Death from high-risk prostate cancer versus cardiovascular mortality with hormonal therapy: a decision analysis.
abstract: BACKGROUND
  Randomized trials have demonstrated improved survival when hormonal therapy (HT) is added to radiation therapy (RT) for high-risk prostate cancer. However, it is still unknown whether men who have a history of myocardial infarction (MI) or MI risk factors achieve a superior outcome from HT.
  
  
  METHODS
  A Markov decision analysis model was used to compare quality-adjusted life expectancy (QALE) in men aged 50, 60, and 70 years who received RT and no HT, 6 months of HT (short-term), or 3 years of HT (long-term) for high-risk prostate cancer stratified by cardiac risk group.
  
  
  RESULTS
  In men with a history of MI, there was a decrease of 0.1 to 0.2 quality-adjusted life years and 0.5 to 0.6 quality-adjusted life years across all ages with short-term HT and long-term HT, respectively, compared with no HT. In men without MI, receipt of short-term or long-term HT was associated with a QALE benefit versus no HT in all cohorts. Among men without MI, the optimal duration of HT was a function of age and the number of MI risk factors. Long-term HT improved QALE (range, 1.4-5.4 years) for men aged 50 or 60 years except those with MI; whereas, for men aged 70 years with 4 cardiac risk factors, short-term and long-term HT yielded identical QALE.
  
  
  CONCLUSIONS
  Men who received RT for high-risk prostate cancer and had a history of MI experienced net harm when they received HT. Men without MI gained a QALE benefit from HT, even if they had up to 4 cardiac risk factors. The optimal duration of HT is a function of patient age and the number of cardiac risk factors.
authors: Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. nataniel.lester-coll@yale.edu
authors: Nataniel H
authors: NH
authors: Lester-Coll
authors: Samuel Z
authors: SZ
authors: Goldhaber
authors: David J
authors: DJ
authors: Sher
authors: Anthony V
authors: AV
authors: D'Amico
mesh_terms: D000367:Age Factors; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D002318:Cardiovascular Diseases / Q000401:mortality*; D017024:Chemotherapy, Adjuvant; D003661:Decision Support Techniques; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000401:mortality* / Q000532:radiotherapy; D019057:Quality-Adjusted Life Years; D018714:Radiotherapy, Adjuvant; D018570:Risk Assessment; D012307:Risk Factors; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D014408:Biomarkers, Tumor; D013739:Testosterone; D017430:Prostate-Specific Antigen