Medical androgen deprivation therapy and increased non-cancer mortality in non-metastatic prostate cancer patients aged ≥66 years.
Abdollah F, Sammon JD, Reznor G, Sood A, Schmid M, Klett DE, Sun M, Aizer AA, Choueiri TK, Hu JC, Kim SP, Kibel AS, Nguyen PL, Menon M, and Trinh QD. Medical androgen deprivation therapy and increased non-cancer mortality in non-metastatic prostate cancer patients aged >/=66 years. Eur J Surg Oncol 2015; 41(11):1529-1539.
European journal of surgical oncology
PURPOSE: To examine the potential relationship between androgen deprivation therapy and other-cause mortality (OCM) in patients with prostate cancer treated with medical primary-androgen deprivation therapy, prostatectomy, or radiation.
METHODS: A total of 137,524 patients with non-metastatic PCa treated between 1995 and 2009 within the Surveillance Epidemiology and End Results Medicare-linked database were included. Cox-regression analysis tested the association of ADT with OCM. A 40-item comorbidity score was used for adjustment.
RESULTS: Overall, 9.3% of patients harbored stage III-IV disease, and 57.7% of patients received ADT. The mean duration of ADT exposure was 22.9 months (median: 9.1; IQR: 2.8-31.5). Mean and median follow-up were 66.9, and 60.4 months, respectively. At 10 years, overall-OCM rate was 36.5%; it was 30.6% in patients treated without ADT vs. 40.1% in patients treated with ADT (p < 0.001). In multivariable-analysis, ADT was associated with an increased risk of OCM (Hazard-ratio [HR]: 1.11, 95% Confidence-interval [95% CI]: 1.08-1.13). Patients with no comorbidity (10-year OCM excess risk: 9%) were more subject to harm from ADT than patients with high comorbidity (10-year OCM excess risk: 4.7%).
CONCLUSIONS: In patients with PCa, treatment with medical ADT may increase the risk of mortality due to causes other than PCa. Whether this is a simple association or a cause-effect relationship is unknown and warrants further study in prospective studies.
Medical Subject Headings
Aged; Aged, 80 and over; Androgen Antagonists; Antineoplastic Agents, Hormonal; Cardiovascular Diseases; Cause of Death; Follow-Up Studies; Humans; Male; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Registries; Risk Assessment; Risk Factors; SEER Program; Survival Rate; United States