Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
World Journal of Urology
Published in: World Journal of Urology 9/2015

01-09-2015 | Original Article

Cardiovascular events associated with androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis

Authors: Arie Carneiro, Andre Deeke Sasse, Andrew Aurel Wagner, Guilherme Peixoto, André Kataguiri, Ary Serpa Neto, Bianca Alves Vieira Bianco, Peter Chang, Antônio Carlos Lima Pompeo, Marcos Tobias-Machado

Published in: World Journal of Urology | Issue 9/2015

Login to get access

Abstract

Context

A recently published meta-analysis of randomized clinical trials (RCT) showed that androgen deprivation therapy (ADT) did not significantly increase cardiovascular mortality in prostate cancer patients. However, cardiovascular morbidity, which can impact quality of life, was not evaluated.

Objective

To evaluate the risk of cardiovascular morbidity associated with ADT in patients with prostate cancer.

Methods

We conducted a literature search from January 1960 to June 2012. RCT and large cohort studies that evaluated first-line endocrine therapy and ADT longer than 6 months were screened for inclusion.

Results

In total, 126,898 patients were included in four cohort studies, and 10,760 patients were included in nine RCTs. Analysis of the RCTs showed no differences in the development of acute myocardial infarction (AMI) (OR 1.23; 95 % CI 0.92–1.64; I 2: 0 %) among the patients receiving ADT or not. The analysis of randomized studies that reported other nonfatal cardiovascular events demonstrated a significant increase in such events in the group receiving ADT (OR 1.55; 95 % CI 1.09–2.20; I 2: 0 %). When the large cohort studies were included in the analysis, an increased risk of AMI among men with ADT was found (OR 2.01, 95 % CI 1.90–2.13; I 2: 91,3 %).

Conclusion

The use of ADT in prostate cancer patients corresponded with a significant increase in cardiovascular morbidity associated with AMI and with nonfatal events. Therefore, ADT is linked to a significant negative impact on quality of life. Periodic cardiovascular evaluation is required for these patients.
Literature
1.
Zagars GK, Johnson DE, von Eschenbach AC, Hussey DH (1988) Adjuvant estrogen following radiation therapy for stage C adenocarcinoma of the prostate: long-term results of a prospective randomized study. Int J Radiat Oncol Biol Phys 14(6):1085–1091CrossRefPubMed
2.
Sasse AD, Sasse E, Carvalho AM, Macedo LT (2012) Androgenic suppression combined with radiotherapy for the treatment of prostate adenocarcinoma: a systematic review. BMC Cancer 12:54PubMedCentralCrossRefPubMed
3.
Nguyen PL, Je Y, Schutz FA, Hoffman KE, Hu JC, Parekh A et al (2011) Association of androgen deprivation therapy with cardiovascular death in patients with prostate cancer: a meta-analysis of randomized trials. JAMA 306(21):2359–2366CrossRefPubMed
4.
Meng MV, Grossfeld GD, Sadetsky N, Mehta SS, Lubeck DP, Carroll PR (2002) Contemporary patterns of androgen deprivation therapy use for newly diagnosed prostate cancer. Urology 60(3 Suppl 1):7–11CrossRefPubMed
5.
Denham JW, Steigler A, Lamb DS, Joseph D, Mameghan H, Turner S et al (2005) Short-term androgen deprivation and radiotherapy for locally advanced prostate cancer: results from the Trans-Tasman Radiation Oncology Group 96.01 randomised controlled trial. Lancet Oncol. 6(11):841–850CrossRefPubMed
6.
Efstathiou JA, Bae K, Shipley WU, Hanks GE, Pilepich MV, Sandler HM et al (2008) Cardiovascular mortality and duration of androgen deprivation for locally advanced prostate cancer: analysis of RTOG 92-02. Eur Urol 54(4):816–823CrossRefPubMed
7.
Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED, Trump D (1999) Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 341(24):1781–1788CrossRefPubMed
8.
Keating NL, O’Malley AJ, Smith MR (2006) Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol 24(27):4448–4456CrossRefPubMed
9.
Serpa Neto A, Tobias-Machado M, Esteves MA, Senra MD, Wroclawski ML, Fonseca FL et al (2012) Bisphosphonate therapy in patients under androgen deprivation therapy for prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 15(1):36–44CrossRefPubMed
10.
D’Amico AV, Chen MH, Renshaw AA, Loffredo M, Kantoff PW (2008) Causes of death in men undergoing androgen suppression therapy for newly diagnosed localized or recurrent prostate cancer. Cancer 113(12):3290–3297CrossRefPubMed
11.
Tsai HK, D’Amico AV, Sadetsky N, Chen MH, Carroll PR (2007) Androgen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. J Natl Cancer Inst 99(20):1516–1524CrossRefPubMed
12.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535PubMedCentralCrossRefPubMed
13.
14.
15.
Sterne JA, Egger M, Smith GD (2001) Systematic reviews in health care: Investigating and dealing with publication and other biases in meta-analysis. BMJ 323(7304):101–105PubMedCentralCrossRefPubMed
16.
Iversen P, Johansson JE, Lodding P, Lukkarinen O, Lundmo P, Klarskov P et al (2004) Bicalutamide (150 mg) versus placebo as immediate therapy alone or as adjuvant to therapy with curative intent for early nonmetastatic prostate cancer: 5.3-year median followup from the Scandinavian Prostate Cancer Group Study Number 6. J Urol 172(5 Pt 1):1871–1876CrossRefPubMed
17.
Wirth M, Tyrrell C, Delaere K, Sanchez-Chapado M, Ramon J, Wallace DM et al (2005) Bicalutamide (‘Casodex’) 150 mg in addition to standard care in patients with nonmetastatic prostate cancer: updated results from a randomised double-blind phase III study (median follow-up 5.1 y) in the early prostate cancer programme. Prostate Cancer Prostatic Dis 8(2):194–200CrossRefPubMed
18.
Iversen P, Johansson JE, Lodding P, Kylmala T, Lundmo P, Klarskov P et al (2006) Bicalutamide 150 mg in addition to standard care for patients with early non-metastatic prostate cancer: updated results from the Scandinavian Prostate Cancer Period Group-6 Study after a median follow-up period of 7.1 years. Scand J Urol Nephrol 40(6):441–452CrossRefPubMed
19.
Studer UE, Whelan P, Albrecht W, Casselman J, de Reijke T, Hauri D et al (2006) Immediate or deferred androgen deprivation for patients with prostate cancer not suitable for local treatment with curative intent: European Organisation for Research and Treatment of Cancer (EORTC) Trial 30891. J Clin Oncol 24(12):1868–1876CrossRefPubMed
20.
Efstathiou JA, Bae K, Shipley WU, Hanks GE, Pilepich MV, Sandler HM et al (2009) Cardiovascular mortality after androgen deprivation therapy for locally advanced prostate cancer: RTOG 85-31. J Clin Oncol 27(1):92–99PubMedCentralCrossRefPubMed
21.
Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff RO, Storme G et al (2010) External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomised study. Lancet Oncol 11(11):1066–1073CrossRefPubMed
22.
Van Hemelrijck M, Garmo H, Holmberg L, Ingelsson E, Bratt O, Bill-Axelson A et al (2010) Absolute and relative risk of cardiovascular disease in men with prostate cancer: results from the population-based PCBaSe Sweden. J Clin Oncol 28(21):3448–3456CrossRefPubMed
23.
24.
Iversen P, McLeod DG, See WA, Morris T, Armstrong J, Wirth MP et al (2010) Antiandrogen monotherapy in patients with localized or locally advanced prostate cancer: final results from the bicalutamide early prostate cancer programme at a median follow-up of 9.7 years. BJU Int 105(8):1074–1081CrossRefPubMed
25.
Alibhai SM, Duong-Hua M, Sutradhar R, Fleshner NE, Warde P, Cheung AM et al (2009) Impact of androgen deprivation therapy on cardiovascular disease and diabetes. J Clin Oncol 27(21):3452–3458CrossRefPubMed
26.
Kapoor D, Jones TH (2008) Androgen deficiency as a predictor of metabolic syndrome in aging men: an opportunity for intervention? Drugs Aging 25(5):357–369CrossRefPubMed
27.
Malkin CJ, Pugh PJ, Morris PD, Asif S, Jones TH, Channer KS (2010) Low serum testosterone and increased mortality in men with coronary heart disease. Heart 96(22):1821–1825CrossRefPubMed
28.
Sanda MG, Dunn RL, Michalski J, Sandler HM, Northouse L, Hembroff L et al (2008) Quality of life and satisfaction with outcome among prostate-cancer survivors. N Engl J Med 358(12):1250–1261CrossRefPubMed
29.
Shahinian VB, Kuo YF, Freeman JL, Goodwin JS (2006) Risk of the “androgen deprivation syndrome” in men receiving androgen deprivation for prostate cancer. Arc Intern Med 166(4):465–471
30.
Roach M 3rd, Bae K, Speight J, Wolkov HB, Rubin P, Lee RJ et al (2008) Short-term neoadjuvant androgen deprivation therapy and external-beam radiotherapy for locally advanced prostate cancer: long-term results of RTOG 8610. J Clin Oncol 26(4):585–591CrossRefPubMed
31.
32.
Hedlund PO, Damber JE, Hagerman I, Haukaas S, Henriksson P, Iversen P et al (2008) Parenteral estrogen versus combined androgen deprivation in the treatment of metastatic prostatic cancer: part 2. Final evaluation of the Scandinavian Prostatic Cancer Group (SPCG) Study No. 5. Scand J Urol Nephrol 42(3):220–229CrossRefPubMed
Metadata
Title
Cardiovascular events associated with androgen deprivation therapy in patients with prostate cancer: a systematic review and meta-analysis
Authors
Arie Carneiro
Andre Deeke Sasse
Andrew Aurel Wagner
Guilherme Peixoto
André Kataguiri
Ary Serpa Neto
Bianca Alves Vieira Bianco
Peter Chang
Antônio Carlos Lima Pompeo
Marcos Tobias-Machado
Publication date
01-09-2015
Publisher
Springer Berlin Heidelberg
Published in
World Journal of Urology / Issue 9/2015
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI
https://doi.org/10.1007/s00345-014-1439-6

Other articles of this Issue 9/2015

World Journal of Urology 9/2015 Go to the issue

Original Article

Impact of gender on success and complication rates after ureteroscopy

Original Article

Significance of baseline bone markers on disease progression and survival in hormone-sensitive prostate cancer with bone metastasis

Topic Paper

The role of bladder neck suspension in the era of mid-urethral sling surgery

Original Article

Surveillance for patients with clinical stage I nonseminomatous testicular germ cell tumors

Original Article

High hospital and surgeon volume and its impact on overall survival after radical cystectomy among patients with bladder cancer in Quebec

Original Article

Urgent percutaneous nephrolithotomy for acute kidney injury secondary to bilateral stones: Is it safe and effective in infants?