Abstract
OBJECTIVESWe investigated whether androgen deprivation therapy (ADT) in prostate cancer patients was associated with a decreased risk for second primary lung cancer in US veterans.METHODSProstate cancer diagnoses in the US Veterans Affairs Cancer Registry between 1999 and 2008 were identified. Use of hormonal therapy and diagnoses of second primary lung cancer were determined from the registry. Synchronous prostate and lung cancers, defined as 2 diagnoses made within 1 year, were excluded from the analysis. Cancer-free survival was estimated using the Kaplan-Meier method and hazard ratios were estimated using Cox proportional hazard models.RESULTSAmong the 63,141 identified patients with prostate cancer, 18,707 subjects were eligible for the study. Hormonal therapy was used in 38% of patients and the median follow-up period was 28 months. ADT use was associated with longer lung cancer-free survival in prostate cancer patients (log-rank p=0.01). After adjusting for age, race, smoking and prostate cancer stage, ADT use was associated with decreased lung cancer risk by 15, 21, and 24% after 1, 2, and 3 years, respectively.CONCLUSIONSADT in prostate cancer patients may be associated with decreased second primary lung cancer risk among US veterans.
Highlights
The endocrine system has been implicated in the development and treatment of various cancers, including breast, prostate, uterine, testicular, ovarian, and thyroid cancers [1]
In a post hoc analysis of the Women’s Health Initiative study, use of a hormone supplement with conjugated equine estrogen and medroxyprogesterone acetate was shown to be significantly associated with increased mortality from non-small cell lung cancer (NSCLC) [4], while estrogen blockade with tamoxifen in breast cancer patients was shown to be associated with decreased mortality from lung cancer [5]
Alcohol use and smoking history were obtained from the National Veterans Affairs Medical SAS dataset and were merged with data obtained from the Veterans’ Affairs Central Cancer Registry (VACCR) using scrambled social security numbers as unique identifiers
Summary
The endocrine system has been implicated in the development and treatment of various cancers, including breast, prostate, uterine, testicular, ovarian, and thyroid cancers [1]. Increasing evidence has implicated estrogen in the development and prog-. In a post hoc analysis of the Women’s Health Initiative study, use of a hormone supplement with conjugated equine estrogen and medroxyprogesterone acetate was shown to be significantly associated with increased mortality from non-small cell lung cancer (NSCLC) [4], while estrogen blockade with tamoxifen in breast cancer patients was shown to be associated with decreased mortality from lung cancer [5]. Androgen receptors (ARs) are expressed in normal lung tissues [6], as well as in cancer cells, including NSCLC [7,8]. The tumor cell proliferation in NSCLC induced by tobacco carcinogens (4-methylnitrosoamino-1-3-pyridyl-1-butanone and benzo[a]pyrene) was shown to be suppressed in AR-knockdown mice [9]
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