Frederik Birkebæk Thomsen1, Fredrik Sandin2, Hans Garmo3, Ingela Franck Lissbrant4, Göran Ahlgren5, Mieke Van Hemelrijck6, Jan Adolfsson7, David Robinson8, Pär Stattin9. 1. Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. Electronic address: thomsen.frederik@gmail.com. 2. Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden. 3. Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden; Cancer Epidemiology Group, School of Medicine, Division of Cancer Studies, King's College London, London, UK. 4. Department of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 5. Department of Urology, SUS Malmö, Region Skåne, Malmö, Sweden. 6. Cancer Epidemiology Group, School of Medicine, Division of Cancer Studies, King's College London, London, UK; Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden. 7. CLINTEC-department, Karolinska Institutet, Stockholm, Sweden. 8. Department of Urology, Ryhov Hospital, Jönköping, Sweden. 9. Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden.
Abstract
BACKGROUND: In observational studies, men with prostate cancer treated with gonadotropin-releasing hormone (GnRH) agonists had a higher risk of cardiovascular disease (CVD) compared to men who had undergone orchiectomy. However, selection bias may have influenced the difference in risk. OBJECTIVE: To investigate the association of type of androgen deprivation therapy (ADT) with risk of CVD while minimising selection bias. DESIGN, SETTING, AND PARTICIPANTS: Semi-ecologic study of 6556 men who received GnRH agonists and 3330 men who underwent orchiectomy as primary treatment during 1992-1999 in the Prostate Cancer Database Sweden 3.0. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We measured the proportion of men who received GnRH agonists as primary treatment in 580 experimental units defined by healthcare provider, diagnostic time period, and age at diagnosis. Incident or fatal CVD events in units with high and units with low use of GnRH agonists were compared. Net and crude probabilities were also analysed. RESULTS AND LIMITATIONS: The risk of CVD was similar between units with the highest and units with the lowest proportion of GnRH agonist use (relative risk 1.01, 95% confidence interval [CI] 0.93-1.11). Accordingly, there was no difference in the net probability of CVD after GnRH agonist compared to orchiectomy (hazard ratio 1.02, 95% CI 0.96-1.09). The 10-yr crude probability of CVD was 0.56 (95% CI 0.55-0.57) for men on GnRH agonists and 0.52 (95% CI 0.50-0.54) for men treated with orchiectomy. The main limitation was the nonrandom allocation to treatment, with younger men with lower comorbidity and less advanced cancer more likely to receive GnRH agonists. CONCLUSION: Our data do not support previous observations that GnRH agonists increase the risk of CVD in comparison to orchiectomy. PATIENT SUMMARY: We found a similar risk of cardiovascular disease between medical and surgical treatment as androgen deprivation therapy for prostate cancer.
BACKGROUND: In observational studies, men with prostate cancer treated with gonadotropin-releasing hormone (GnRH) agonists had a higher risk of cardiovascular disease (CVD) compared to men who had undergone orchiectomy. However, selection bias may have influenced the difference in risk. OBJECTIVE: To investigate the association of type of androgen deprivation therapy (ADT) with risk of CVD while minimising selection bias. DESIGN, SETTING, AND PARTICIPANTS: Semi-ecologic study of 6556 men who received GnRH agonists and 3330 men who underwent orchiectomy as primary treatment during 1992-1999 in the Prostate Cancer Database Sweden 3.0. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: We measured the proportion of men who received GnRH agonists as primary treatment in 580 experimental units defined by healthcare provider, diagnostic time period, and age at diagnosis. Incident or fatal CVD events in units with high and units with low use of GnRH agonists were compared. Net and crude probabilities were also analysed. RESULTS AND LIMITATIONS: The risk of CVD was similar between units with the highest and units with the lowest proportion of GnRH agonist use (relative risk 1.01, 95% confidence interval [CI] 0.93-1.11). Accordingly, there was no difference in the net probability of CVD after GnRH agonist compared to orchiectomy (hazard ratio 1.02, 95% CI 0.96-1.09). The 10-yr crude probability of CVD was 0.56 (95% CI 0.55-0.57) for men on GnRH agonists and 0.52 (95% CI 0.50-0.54) for men treated with orchiectomy. The main limitation was the nonrandom allocation to treatment, with younger men with lower comorbidity and less advanced cancer more likely to receive GnRH agonists. CONCLUSION: Our data do not support previous observations that GnRH agonists increase the risk of CVD in comparison to orchiectomy. PATIENT SUMMARY: We found a similar risk of cardiovascular disease between medical and surgical treatment as androgen deprivation therapy for prostate cancer.
Authors: Sakthivel Muniyan; Lei Xi; Kaustubh Datta; Anindita Das; Benjamin A Teply; Surinder K Batra; Rakesh C Kukreja Journal: Biochim Biophys Acta Rev Cancer Date: 2020-06-11 Impact factor: 10.680
Authors: Cicero P Albuquerque; Fatima R Freitas; Ana Elisa M Martinelli; Josefa H Lima; Rafael F Coelho; Carlos V Serrano; Willian C Nahas; Roberto Kalil Filho; Raul C Maranhão Journal: Lipids Health Dis Date: 2020-06-10 Impact factor: 3.876
Authors: Youquan Li; Whee Sze Ong; Ma Than Than Shwe; Nelson Ling Fung Yit; Sheriff Zhan Hong Quek; Eric Pei Ping Pang; Wen Shen Looi; Wen Long Nei; Michael Lian Chek Wang; Melvin Lee Kiang Chua; Terence Wee Kiat Tan; Eu Tiong Chua; Choon Ta Ng; Jeffrey Kit Loong Tuan Journal: Cardiooncology Date: 2022-03-14