Alyssa K Greiman1, Thomas E Keane2. 1. Department of Urology, Medical University of South Carolina, 96 Jonathan Lucas St., CSB 644, Charleston, SC, USA. greiman@musc.edu. 2. Department of Urology, Medical University of South Carolina, 96 Jonathan Lucas St., CSB 644, Charleston, SC, USA.
Abstract
PURPOSE OF REVIEW: Androgen deprivation therapy (ADT) is a mainstay of treatment for advanced prostate cancer. Several studies have reported an association between ADT and an increase in cardiovascular events, especially in those receiving gonadotropin-releasing hormone (GnRH) agonists compared to GnRH antagonists. We review the body of literature reporting the association of ADT and cardiovascular morbidity, and discuss the proposed mechanism of cardiovascular disease due to ADT including metabolic changes that may promote atherosclerosis and local hormonal effects that may increase plaque rupture and thrombosis. RECENT FINDINGS: GnRH agonists appear to increase the risk of cardiovascular morbidity by 20-25% in men on these agents compared those who do not receive ADT. GnRH antagonists may appear to have halve this risk while improving PSA progression-free survival. GnRH antagonists may be superior to GnRH agonists for patients with significant cardiovascular disease, significant metastatic disease burden, or severe lower urinary tract symptoms.
PURPOSE OF REVIEW: Androgen deprivation therapy (ADT) is a mainstay of treatment for advanced prostate cancer. Several studies have reported an association between ADT and an increase in cardiovascular events, especially in those receiving gonadotropin-releasing hormone (GnRH) agonists compared to GnRH antagonists. We review the body of literature reporting the association of ADT and cardiovascular morbidity, and discuss the proposed mechanism of cardiovascular disease due to ADT including metabolic changes that may promote atherosclerosis and local hormonal effects that may increase plaque rupture and thrombosis. RECENT FINDINGS:GnRH agonists appear to increase the risk of cardiovascular morbidity by 20-25% in men on these agents compared those who do not receive ADT. GnRH antagonists may appear to have halve this risk while improving PSA progression-free survival. GnRH antagonists may be superior to GnRH agonists for patients with significant cardiovascular disease, significant metastatic disease burden, or severe lower urinary tract symptoms.
Authors: Ferenc G Rick; Andrew V Schally; Norman L Block; Gabor Halmos; Roberto Perez; Jesus B Fernandez; Irving Vidaurre; Luca Szalontay Journal: Prostate Date: 2010-10-13 Impact factor: 4.104
Authors: Fernando E C Calais da Silva; Aldo V Bono; Peter Whelan; Maurizio Brausi; Anton Marques Queimadelos; Jose A Portillo Martin; Ziya Kirkali; Fernando M V Calais da Silva; Chris Robertson Journal: Eur Urol Date: 2009-02-21 Impact factor: 20.096
Authors: Jason A Efstathiou; Kyounghwa Bae; William U Shipley; Gerald E Hanks; Miljenko V Pilepich; Howard M Sandler; Matthew R Smith Journal: Eur Urol Date: 2008-01-15 Impact factor: 20.096