The use of short-course androgen deprivation therapy (ADT) in association with external-beam radiation therapy (RT) to treat localized, low- and intermediate-risk prostate cancer is not associated with a greater risk of cardiac death, contrary to long-standing concerns.1
A number of studies have suggested links between the use of gonadotropin-releasing hormone (GnRH) agonist and cardiovascular disease and diabetes in men with prostate cancer.
In 2010, this prompted a science advisory for the potential increased risk of myocardial infarction, strokes, sudden cardiac death, and diabetes with these agents.2 As a result, there has been ongoing controversy surrounding whether these agents could lead to cardiac death.
But a retrospective analysis of a large randomized controlled trial has found no evidence to support a link between ADT and cardiac death. 1
The study analyzed overall and disease-specific survival in a total of 1,979 men with clinically localized prostate cancer enrolled in Radiation Therapy Oncology Group (RTOG) 94-08 from 1994 to 2001.
Patients were randomized to RT with and without short-course ADT. In the analysis, researchers assessed overall and disease-specific survival (DSS). They found that short-course ADT improved both overall survival and DSS and was not associated with increased risk of cardiovascular mortality.
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The study was unique in that all risk groups were represented in the trial. “The advantage of this study, which is consistent with a lot of other work, is that it’s generated from a randomized controlled trial of almost 2,000 patients,” said Jason Efstathiou, MD, DPhil, of Massachusetts General Hospital in Boston, MA, during an interview with Cancer Therapy Advisor. “Our study looks at all risk groups: low, intermediate, and high.”
Nine percent of the study’s patients were grouped as high risk, 55% as intermediate risk, and 36% as low risk. “The study is really informative on the low and intermediate risk, and that’s where you’ll find most of the controversy [around using ADT],” said Dr. Efstathiou.