Does androgen deprivation therapy impair renal function in patients with prostate cancer?

Abstract

323 Background: While the adverse effects of androgen deprivation therapy (ADT) in patients with prostate cancer are generally well-known among physicians, it is not clear whether ADT affects renal function. Therefore, the goal of the present study was to assess changes in renal function in response to ADT for 1 year. Methods: Patients with prostate cancer who were hormone-naïve and scheduled to receive long-term ADT were recruited between 2011 and 2013. Body weight and blood testing, including lipid and glucose metabolism and renal function, were recorded every 3 months during 1 year of ADT. Estimated glomerular filtration rate (eGFR) was calculated based on baseline age throughout ADT. Computed tomography (CT) was performed to measure psoas muscle area before and after 1 year of ADT to evaluate the influence of a decrease in lean mass on renal function. ADT was limited to a luteinizing hormone-releasing hormone agonist with or without bicalutamide. Patients who had severe renal dysfunction (eGFR < 30 mL/min/m2) or who had disease progression during 1 year of ADT were excluded from analyses. Results: Of 217 registered patients, renal function data were available from 170 patients who completed 1 year of ADT. Mean changes in serum creatinine and eGFR were 1.3% and 0.2%, respectively. Prostate specific antigen, clinical stage, body mass index, total testosterone, hemoglobin A1c, creatinine, eGFR, and comorbidities (e.g., hypertension, dyslipidemia, diabetes mellitus, cardiovascular disease) at baseline were not associated with a change in renal function. Age < 70 years at baseline was associated with an increase in eGFR in univariate and multivariate analyses (univariate: P = 0.01, multivariate: 95% confidence interval 1.13-4.87, P = 0.03). CT was performed in 72 patients before and after 1 year of ADT. The mean decrease in psoas muscle area was -8.4%. Decrease in psoas muscle area and increase of eGFR were more frequent in patients of age < 70 years than in those of age ≥ 70 years (psoas muscle: -10.2% vs. -7.5%, P = 0.05; eGFR: 6.4% vs. 0.2%, P = 0.03). Conclusions: ADT did not impair renal function in patients with prostate cancer. eGFR was more likely to increase in younger patients, but this increase may be due to a decrease in lean mass. Clinical trial information: UMIN000004709.