UroToday - Cardiovascular Mortality After Androgen Deprivation Therapy for Locally Advanced Prostate Cancer: RTOG 85-31 - Abstract

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Monday, 22 December 2008

Department of Radiation Oncology and Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA.

Department of Statistics, Radiation Therapy Oncology Group, Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA; Department of Radiation Oncology, University of California, Los Angeles School of Medicine, Los Angeles, CA; and Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI.

Gonadotropin-releasing hormone (GnRH) agonists are associated with greater risk of coronary heart disease and myocardial infarction in men with prostate cancer, but little is known about potential impact on cardiovascular mortality. We assessed the relationship between GnRH agonists and cardiovascular mortality in a large randomized phase III trial of men treated with or without adjuvant goserelin after radiation therapy (RT) for locally advanced prostate cancer.

Between 1987 and 1992, 945 men with locally advanced prostate cancer were randomly assigned to RT and adjuvant goserelin or RT alone. Fine and Gray's regression was used to evaluate treatment effect on cardiovascular mortality. Covariates included age, prevalent cardiovascular disease (CVD), hypertension, diabetes mellitus (DM), body mass index, race, Gleason score, stage, acid phosphatase level, prostatectomy history, and nodal involvement.

After a median follow-up of 8.1 years, there were 117 cardiovascular-related deaths but no treatment-related increase in cardiovascular mortality. At 9 years, cardiovascular mortality for men receiving adjuvant goserelin was 8.4% v 11.4% for men treated without adjuvant goserelin (Gray's P = .17). In multiple regression analyses, treatment arm was not significantly associated with increased risk of cardiovascular mortality (adjusted hazard ratio

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= 0.73; 95% CI, 0.47 to 1.15; P = .16; when censoring at time of salvage goserelin therapy, HR = 0.99; 95% CI, 0.58 to 1.69; P = .97). Traditional cardiac risk factors, including prevalent CVD and DM, were significantly associated with greater cardiovascular mortality.

GnRH agonists do not seem to increase cardiovascular mortality in men with locally advanced prostate cancer. Further studies are warranted to evaluate adverse effects of GnRH agonists in men with lower cancer-specific mortality.

Written by: Efstathiou JA, Bae K, Shipley WU, Hanks GE, Pilepich MV, Sandler HM, MR. Are you the author?

Reference: J Clin Oncol. 2008 Dec 1. Epub ahead of print. doi:10.1200/JCO.2007.12.3752

PubMed Abstract PMID:19047297

http://www.urotoday.com/61/browse_categories/prostate_cancer/cardiovascular_mortality_after_androgen_deprivation_therapy_for_locally_advanced_prostate_cancer_rtog_8531__abstract.html