Tsai HK et al. (2007) Androgen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. J Natl Cancer Inst 99: 1516–1524

Combination use of androgen deprivation therapy (ADT) and local therapy for localized prostate cancer is increasing; however, patients treated with ADT have an increased risk of developing the metabolic syndrome and, subsequently, cardiovascular disease. Tsai and colleagues conducted a retrospective study to investigate whether patients with localized prostate cancer treated with ADT also have an increased risk of death from cardiovascular events.

The study analyzed data from patients who had undergone prostatectomy (n = 3,262) or had been treated with external beam radiotherapy, brachytherapy or cryotherapy (n = 1,630) for localized prostate cancer. ADT had been received by 266 patients who underwent prostatectomy and 749 patients treated with the other therapies; median duration of ADT use overall was 4.1 months. During follow-up (median 3.8 years), 131 patients died of cardiovascular causes.

After controlling for age and cardiovascular disease risk factors, among patients who underwent prostatectomy, both use of ADT and older age were associated with an increased risk of death due to cardiovascular events. Furthermore, 5-year cumulative incidence of cardiovascular deaths in patients aged ≥65 years who had undergone prostatectomy was 5.5% among patients who had received ADT but only 2.0% among those who had not. ADT use also increased 5-year cumulative incidence of deaths from cardiovascular events in patients ≥65 years who had received radiotherapy, brachytherapy or cryotherapy, but the results were not significant.

Prospective studies are necessary to confirm these findings; nevertheless, patients considered for ADT should undergo a careful cardiovascular evaluation.