title: Relationship between androgen deprivation therapy and community-acquired respiratory infections in patients with prostate cancer.
abstract: OBJECTIVE
  To investigate the dose-dependent effect of androgen deprivation therapy on community-acquired respiratory infections in patients with localized prostate cancer.
  
  
  METHODS
  We identified 52 905 men diagnosed with localized prostate cancer within the Surveillance, Epidemiology and End Results-Medicare database between 1991 and 2006. We compared those who did not receive androgen deprivation therapy with those who received androgen deprivation therapy within 2 years of diagnosis, calculated as monthly equivalent doses (<7, 7-11, >11 doses), or orchiectomy. Adjusted Cox hazard models were fitted to predict the risk of community-acquired respiratory infections (acute sinusitis, acute bronchitis, [severe] pneumonia) in patients treated with medical androgen deprivation therapy versus orchiectomy versus none.
  
  
  RESULTS
  Overall, 43.4% received medical androgen deprivation therapy. These patients more likely experienced respiratory events compared with those who did not receive androgen deprivation therapy or who underwent orchiectomy (62.2% vs 54.5% vs 47.8%, P < 0.001). The risk of experiencing any respiratory event increased with the number of doses received. For example, men receiving >11 doses of androgen deprivation therapy were at greatest risk of acute sinusitis, acute bronchitis and pneumonia (HR 1.13, 1.26 and 1.15, respectively, all P < 0.001), except severe pneumonia. Furthermore, we did not detect any relationship between orchiectomy and respiratory events. Study limitations include the utilization of a retrospective population-based dataset.
  
  
  CONCLUSIONS
  Increased exposure to medical androgen deprivation therapy for men with localized prostate cancer is associated with a higher risk of community-acquired respiratory infections. Our results suggest that respiratory complications represent potentially underreported complications of medical androgen deprivation therapy.
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Marianne
authors.initials: M
authors.lastname: Schmid
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany.
authors.forename: Julian
authors.initials: J
authors.lastname: Hanske
authors.affiliation: Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Praful
authors.initials: P
authors.lastname: Ravi
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Nandita
authors.initials: N
authors.lastname: Krishna
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Gally
authors.initials: G
authors.lastname: Reznor
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.|Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian P
authors.initials: CP
authors.lastname: Meyer
authors.affiliation: Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Margit
authors.initials: M
authors.lastname: Fisch
authors.affiliation: Department of Urology, Marien Hospital, Ruhr-University Bochum, Herne, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.affiliation: Center for Surgery and Public Health and Division of Urologic Surgery, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Quoc-Dien
authors.initials: QD
authors.lastname: Trinh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009919:Orchiectomy; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000601:surgery; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D012189:Retrospective Studies; D012306:Risk
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal
keywords: Surveillance, Epidemiology and End Results-Medicare; androgen deprivation therapy; pneumonia; prostate cancer; respiratory infections