title: Identification of comorbidities that place men at highest risk of death from androgen deprivation therapy before brachytherapy for prostate cancer.
abstract: OBJECTIVE
  To determine which specific comorbidities predispose men to excess mortality by androgen deprivation therapy (ADT) given before and during brachytherapy for prostate cancer.
  
  
  METHODS
  We analyzed 5972 men with T1c-T3b prostate cancer treated with brachytherapy-based radiation with or without neoadjuvant ADT. Cox multivariable analysis with propensity scoring was used to determine if ADT was associated with increased all-cause mortality (ACM) in men divided into groups stratified by cardiac comorbidities. Tests for interaction between risk group and outcome were performed.
  
  
  RESULTS
  ADT was associated with increased ACM in men with a history of myocardial infarction or congestive heart failure, regardless of whether they underwent revascularization (adjusted hazard ratio [AHR], 2.1 [95% confidence interval {CI}, 1.02-4.17; p=0.04]) or not (AHR, 1.8 [95% CI, 1.05-3.20; p = 0.03]), but this effect was not seen in men with less severe comorbidity. However, among men with diabetes, there was a significant interaction with risk group (p=0.01) such that ADT was associated with excess mortality in men with low-risk disease (AHR = 2.21 [1.04-4.68]; p=0.04) but not in men with intermediate or high-risk disease (AHR, 0.64 [0.33-1.22]; p=0.17).
  
  
  CONCLUSIONS
  ADT was associated with excess ACM in all patients with a history of congestive heart failure or myocardial infarction, regardless of whether they were revascularized, and in diabetics with low-risk disease. ADT for gland downsizing before brachytherapy should be avoided in these men.
authors: Department of Radiation Oncology, Dana Farber/Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors: Arti
authors: A
authors: Parekh
authors: Ming-Hui
authors: MH
authors: Chen
authors: Anthony V
authors: AV
authors: D'Amico
authors: Daniel E
authors: DE
authors: Dosoretz
authors: Rudi
authors: R
authors: Ross
authors: Sharon
authors: S
authors: Salenius
authors: Powell L
authors: PL
authors: Graham
authors: Joshua A
authors: JA
authors: Beckman
authors: Clair J
authors: CJ
authors: Beard
authors: Toni K
authors: TK
authors: Choueiri
authors: Ronald D
authors: RD
authors: Ennis
authors: Karen E
authors: KE
authors: Hoffman
authors: Jim C
authors: JC
authors: Hu
authors: Jing
authors: J
authors: Ma
authors: Neil E
authors: NE
authors: Martin
authors: Paul L
authors: PL
authors: Nguyen
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000008:administration & dosage*; D001918:Brachytherapy / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology*; D020360:Neoadjuvant Therapy; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D000726:Androgen Antagonists
keywords: Androgen deprivation therapy; Cardiac death; Comorbidity; Diabetes; Prostate cancer