Cardiovascular Causes of Death in Patients Treated for Localized Prostate Cancer

Abstract

<h3>Purpose/Objective(s)</h3> From two trials in localized prostate cancer, cardiovascular disease represented the second cause of death. Based on our own data, we retrieved and reviewed the clinical information on those patients labelled by investigators as dying from cardiovascular disease (CVD) aiming to confirm and precisely define the cause/diagnosis of their cardiovascular death. <h3>Materials/Methods</h3> From October 2000 to September 2010, 1230 patients were randomized into two prostate cancer trials. Causes of death compiled up to January 2022, were based on data from clinical records, death certificates, obituaries, family members, and family physicians. Patients who were reported dying from CVD were classified into 2 groups: cardiac events proper and vascular events outside the heart. <h3>Results</h3> With a median follow up of 13.4 years, 663/1230 (53.9%) patients had died, 274 in IRPC and 389 in HRPC. 6 of the 136 patients reported dead from CVD were excluded: 3 pulmonary embolisms, 1 thrombosis, 1 severe veno-occlusive disease and 1 aorto-thoracic dissection. A total of 130/663 (19.6%) patients died from CVD. No significant differences were seen in the group of cardiac events proper [47/274 (17.2%) vs 56/389 (14.4%), p=0.4], or in vascular events outside the heart [15/274 (5.5%) vs 12/389 (3.1%), p=0.2] between IRPC and HRPC patients, respectively. The group of CVD deaths from cardiac events accounted for 79.2% (103/130) of all deaths. Many different diagnoses were attributed as potential cause of cardiac death; coronary heart disease was the most frequent 70.8%, followed by heart rhythm disorders 5.4% and heart valve disease 3.1%. The second group of CVD deaths made of vascular events outside the heart represented 20.8% (27/130) of all CVD deaths. <h3>Conclusion</h3> In localized prostate cancer, deaths from CVD represented almost 20% of all causes of death as per original definition from investigators. Of these, deaths linked to a truly cardiac event occurred in 79.2% of the cohort with the remaining deaths attributed to vascular events outside the heart. Notwithstanding potential caveats related to the retrospective nature of this review, this differentiation seems appropriate and may aid in better assessing the possible relationship between ADT and its real impact on the heart.