F Abdollah1, J D Sammon2, G Reznor3, A Sood2, M Schmid4, D E Klett2, M Sun5, A A Aizer6, T K Choueiri7, J C Hu8, S P Kim9, A S Kibel3, P L Nguyen10, M Menon2, Q-D Trinh3. 1. Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA. Electronic address: firas.abdollah@gmail.com. 2. Vattikuti Urology Institute & VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, MI, USA. 3. Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 4. Division of Urologic Surgery and Center for Surgery & Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 5. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada. 6. Harvard Radiation Oncology Program, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 7. Department of Medical Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. 8. Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, USA. 9. Department of Urology, Yale University, New Haven, CT, USA. 10. Department of Radiation Oncology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
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.
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.
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