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A meta-analysis of cardiovascular events in intermittent androgen-deprivation therapy versus continuous androgen-deprivation therapy for prostate cancer patients

Prostate Cancer and Prostatic Diseases volume 19, pages 333–339 (2016)Cite this article

Subjects

A Corrigendum to this article was published on 27 September 2016

Abstract

Background:

Androgen-deprivation therapy (ADT) is the standard treatment for advanced and recurrent prostate cancer but it has been shown to cause adverse effects on the cardiovascular system. Intermittent androgen deprivation has been studied as an alternative therapy. To conduct a meta-analysis comparing the incidence of cardiovascular events in patients with prostate cancer receiving intermittent (IADT) versus continuous ADT (CADT).

Methods:

We searched Cochrane CENTRAL, PubMed/Medline, Embase, Web of Science, The National Cancer Institute Clinical Trials and The Clinical Trials Register of Trials Central, and Google Scholar from inception of each database through February 2016. References from published guidelines, reviews and other relevant articles were also considered. We selected randomized clinical trials comparing IADT versus CADT in patients with prostate cancer that reported data on cardiovascular events. Two reviewers performed the study selection, data abstraction and risk of bias assessment. We calculated risk ratios with the Mantel–Haenszel method, using random effect models. We assessed heterogeneity using I2 index. The primary outcome was incidence of cardiovascular events. Secondary outcomes were thromboembolic events and cardiovascular-related mortality.

Results:

Out of 106 references, we included seven articles from six trials (4810 patients) published between 2009 and 2015. We observed no significant difference between intermittent versus continuous androgen deprivation with respect to cardiovascular events (risk ratio (RR): 0.95; confidence interval (CI) 95%=0.83–1.08; seven trials, 4810 patients) and thromboembolic events (RR: 1.05; CI 95%=0.85–1.30; three trials, 1816 patients). There was marginally significant difference with respect to cardiovascular-related mortality (RR: 0.85; CI 95%=0.71–1.00; five trials, 4170 patients).

Conclusions:

Compared with CADT, IADT shows no difference in terms of cardiovascular events and thromboembolic events. However, there was an association between lower cardiovascular-related mortality and intermittent androgen deprivation.

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Acknowledgements

This study was supported by grants from the National Natural Science Foundation of China to Wei Yu (http://www.nsfc.gov.cn/publish/portal1/) (Grant Nos. 81200548). The supporting institution had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

Drs C Jin and Y Fan had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: J Jin, Y Wei and C Jin. Acquisition, analysis or interpretation of data: C Jin, Y Fan, C Zhan, Y Meng, Y Wang, C Cui and S Hu. Drafting of the manuscript: C Jin, Y Fan and Y Wei. Critical revision of the manuscript for important intellectual content: C Jin, Y Fan, T Xu, Y Wei and C Jin. Statistical analysis: C Jin, Y Fan. Obtained funding: Y Wei. Administrative, technical or material support: Y Fan. Study supervision: J Jin and Y Wei.

Additional Contributions: We are thankful to Anthony ET Yeo, MBBS, MPH, PhD, for editing assistance and statistical analysis, and Jun Zhong, MSc and Aoming Jin MSc for statistical analysis. Dr Yeo is a statistic analyst, Mr Zhong is a professor at the School of Public Health, Peking University Health Science Center, Beijing, China and Ms Jin is a Master of Science student at Peking University Clinical Research Institute. They were not compensated for their contributions beyond their normal employment compensation.

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Authors and Affiliations

  1. Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, Urogenital Diseases (male) Molecular Diagnosis and Treatment Center, National Research Center for Genitourinary Oncology, Beijing, China

    C Jin, Y Fan, Y Meng, C Shen, Y Wang, S Hu, W Yu & J Jin

  2. Department of Urology, Peking University People’s Hospital, Beijing, China,

    C Jin & T Xu

  3. Peking University Health Science Center, Beijing, China

    C Cui

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Correspondence to W Yu.

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Jin, C., Fan, Y., Meng, Y. et al. A meta-analysis of cardiovascular events in intermittent androgen-deprivation therapy versus continuous androgen-deprivation therapy for prostate cancer patients. Prostate Cancer Prostatic Dis 19, 333–339 (2016). https://doi.org/10.1038/pcan.2016.35

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