title: Medical androgen deprivation therapy and increased non-cancer mortality in non-metastatic prostate cancer patients aged ≥66 years.
abstract: OBJECTIVE
  To examine the potential relationship between androgen deprivation therapy and other-cause mortality (OCM) in patients with prostate cancer treated with medical primary-androgen deprivation therapy, prostatectomy, or radiation.
  
  
  METHODS
  A total of 137,524 patients with non-metastatic PCa treated between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included. Cox-regression analysis tested the association of ADT with OCM. A 40-item comorbidity score was used for adjustment.
  
  
  RESULTS
  Overall, 9.3% of patients harbored stage III-IV disease, and 57.7% of patients received ADT. The mean duration of ADT exposure was 22.9 months (median: 9.1; IQR: 2.8-31.5). Mean and median follow-up were 66.9, and 60.4 months, respectively. At 10 years, overall-OCM rate was 36.5%; it was 30.6% in patients treated without ADT vs. 40.1% in patients treated with ADT (p < 0.001). In multivariable-analysis, ADT was associated with an increased risk of OCM (Hazard-ratio [HR]: 1.11, 95% Confidence-interval [95% CI]: 1.08-1.13). Patients with no comorbidity (10-year OCM excess risk: 9%) were more subject to harm from ADT than patients with high comorbidity (10-year OCM excess risk: 4.7%).
  
  
  CONCLUSIONS
  In patients with PCa, treatment with medical ADT may increase the risk of mortality due to causes other than PCa. Whether this is a simple association or a cause-effect relationship is unknown and warrants further study in prospective studies.
authors.affiliation: Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA. Electronic address: firas.abdollah@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: Abdollah
authors.affiliation: Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Sammon
authors.affiliation: Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: G
authors.initials: G
authors.lastname: Reznor
authors.affiliation: Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
authors.forename: A
authors.initials: A
authors.lastname: Sood
authors.affiliation: Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Klett
authors.affiliation: Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Sun
authors.affiliation: Harvard Radiation Oncology Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: A A
authors.initials: AA
authors.lastname: Aizer
authors.affiliation: Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: T K
authors.initials: TK
authors.lastname: Choueiri
authors.affiliation: Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, USA.
authors.forename: J C
authors.initials: JC
authors.lastname: Hu
authors.affiliation: Department of Urology, Yale University, New Haven, CT, USA.
authors.forename: S P
authors.initials: SP
authors.lastname: Kim
authors.affiliation: Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: A S
authors.initials: AS
authors.lastname: Kibel
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: P L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Menon
authors.affiliation: Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Q-D
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000150:complications / Q000628:therapy*; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D018426:SEER Program; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal
keywords: Androgen deprivation therapy; Comorbidity; Competing-risks; Other-cause mortality; Prostate cancer