170 ANDROGEN DEPRIVATION THERAPY FOR NON-METASTATIC PROSTATE CANCER IS ASSOCIATED WITH AN INCREASED RISK OF PERIPHERAL ARTERIAL DISEASE AND VENOUS THROMBOEMBOLISM

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You have accessJournal of UrologyProstate Cancer: Epidemiology and Natural History I1 Apr 2012170 ANDROGEN DEPRIVATION THERAPY FOR NON-METASTATIC PROSTATE CANCER IS ASSOCIATED WITH AN INCREASED RISK OF PERIPHERAL ARTERIAL DISEASE AND VENOUS THROMBOEMBOLISM Jim Hu, Stephen Williams, A. O'Malley, Matthew Smith, Paul Nguyen, and Nancy Keating Jim HuJim Hu Boston, MA More articles by this author , Stephen WilliamsStephen Williams Orange, CA More articles by this author , A. O'MalleyA. O'Malley Boston, MA More articles by this author , Matthew SmithMatthew Smith Boston, MA More articles by this author , Paul NguyenPaul Nguyen Boston, MA More articles by this author , and Nancy KeatingNancy Keating Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.221AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous studies demonstrate that androgen deprivation therapy (ADT) with gonodotropin-releasing hormone (GnRH) agonists and orchiectomy for prostate cancer (CaP) is associated with cardiovascular disease. However, few studies have examined its effect on the peripheral vascular system. The objective of the surrent study was to assess the risk of peripheral arterial disease (PAD) and venous thromboembolism (VTE) associated with ADT for prostate cance CaP. METHODS Population-based observational study of 182,757 U.S. men aged 66 years and older who were diagnosed with nonloco-metastaticregional prostate cancer CaP from 1992 to 2007, of whom 47.8% received GnRH agonists and 2.2% orchiectomy. We used Cox proportional hazards models with time-varying treatment variables to assess whether treatment with GnRH agonists or orchiectomy was associated with PAD and/or VTE. RESULTS GnRH agonist use was associated with an increased risk of incident PAD (adjusted hazard ratio [HR], 1.16, 95% confidence interval [CI] 1.09-1.21) and incident VTE (adjusted HR, 1.09, 95% CI 1.04-1.15). In addition, orchiectomy was associated with an increased risk of PAD (adjusted HR, 1.13, 95% CI 1.02-1.26) and VTE (adjusted HR, 1.21, 95% CI 1.05-1.38). Limitations include the observational study design, inability to assess the use of oral anti-androgens as monotherapy or combined androgen deprivation. CONCLUSIONS ADT for loco-regional non-metastatic CaP is associated with an increased risk of peripheral artery disease and VTE. Additional research is needed to better understand the potential risks and benefits, so that these treatments can be targeted to patients where the benefits are most clear. Table 1. Adjusted association of the duration of GnRH Agonist therapy and outcomes⁎ Duration of GnRH agonist Incident PAD Incident VTE Treatment (Months)† Adjusted HR 95% CI p-value⁎ Adjusted HR 95% CI p-value⁎ No Treatment Ref – Ref – 1-4 1.11 1.05–1.19 0.002 0.88 0.80–0.96 0.003 5-12 1.22 1.15–1.29 <0.001 1.18 1.08–1.29 <0.001 13-24 1.13 1.05–1.22 0.008 1.27 1.15–1.41 <0.001 >25 1.17 1.09–1.26 <0.001 1.18 1.06–1.30 0.002 ⁎ Using time-varying Cox proportional hazards models adjusting for all variables in Table 1 and orchiectomy. † For the peripheral artery disease cohort, the proportion of patient time contributed by duration categories was: no treatment 84.3%; 1-4 months 4.5%; 5-12 months 4.7%; 13-24 months 3.0%; and >25 months 3.5%. For the VTE cohort, the proportion of patient time contributed by duration categories was: no treatment 84.2%; 1-4 months 4.6%; 5-12 months 4.8%; 13-24 months 3.0%; and >25 months 3.5%. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e71 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jim Hu Boston, MA More articles by this author Stephen Williams Orange, CA More articles by this author A. O'Malley Boston, MA More articles by this author Matthew Smith Boston, MA More articles by this author Paul Nguyen Boston, MA More articles by this author Nancy Keating Boston, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...