title: Association of androgen-deprivation therapy with excess cardiac-specific mortality in men with prostate cancer.
abstract: OBJECTIVE
  To determine if androgen-deprivation therapy (ADT) is associated with excess cardiac-specific mortality (CSM) in men with prostate cancer and no cardiovascular comorbidity, coronary artery disease risk factors, or congestive heart failure (CHF) or past myocardial infarction (MI).
  
  
  METHODS
  In all, 5077 men (median age 69.5 years) with cT1c-T3N0M0 prostate cancer were treated with brachytherapy with or without neoadjuvant ADT (median duration 4 months) between 1997 and 2006. Fine and Gray competing risks analysis evaluated the association of ADT with CSM, adjusting for age, year of brachytherapy, and ADT treatment propensity score among men in groups defined by cardiac comorbidity.
  
  
  RESULTS
  After a median follow-up of 4.8 years, no association was detected between ADT and CSM in men with no cardiac risk factors (1.08% at 5 years for ADT vs 1.27% at 5 years for no ADT, adjusted hazard ratio (AHR) 0.83; 95% confidence interval (CI), 0.39-1.78; P = 0.64; n = 2653) or in men with diabetes mellitus, hypertension, or hypercholesterolaemia (2.09% vs 1.97%, AHR 1.33; 95% CI 0.70-2.53; P = 0.39; n = 2168). However, ADT was associated with significantly increased CSM in men with CHF or MI (AHR 3.28; 95% CI 1.01-10.64; P = 0.048; n = 256). In this subgroup, the 5-year cumulative incidence of CSM was 7.01% (95% CI 2.82-13.82%) for ADT vs 2.01% (95% CI 0.38-6.45%) for no ADT.
  
  
  CONCLUSIONS
  ADT was associated with a 5% absolute excess risk of CSM at 5 years in men with CHF or prior MI, suggesting that administering ADT to 20 men in this potentially vulnerable subgroup could result in one cardiac death.
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Ziehr
authors.affiliation: Department of Statistics, University of Connecticut, Storrs, CT, USA.
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Statistics, University of Connecticut, Storrs, CT, USA.
authors.forename: Danjie
authors.initials: D
authors.lastname: Zhang
authors.affiliation: Prostate Cancer Foundation of Chicago, Westmont, IL, USA.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Braccioforte
authors.affiliation: Prostate Cancer Foundation of Chicago, Westmont, IL, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Moran
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: Mahal
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Hyatt
authors.affiliation: Department of Endocrinology, Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Shehzad S
authors.initials: SS
authors.lastname: Basaria
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Clair J
authors.initials: CJ
authors.lastname: Beard
authors.affiliation: Department of Cardiology, Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Beckman
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Anthony V
authors.initials: AV
authors.lastname: D'Amico
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.affiliation: Department of Urology, The University of California Los Angeles (UCLA) Medical Center, Los Angeles, CA, USA.
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Neil E
authors.initials: NE
authors.lastname: Martin
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sweeney
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Houston, TX, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D003327:Coronary Disease / Q000401:mortality*; D017273:Goserelin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016729:Leuprolide / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal; D017273:Goserelin; D016729:Leuprolide
keywords: antineoplastic agents; coronary disease; goserelin; leuprolide; prostate; prostatic neoplasms