Researchers also found that there was no evidence that ADT increased risk of cardiac death among patients with high comorbidity. “We looked at all the patients over the age of 70 and who had a preexisting condition of cardiac disease or diabetes,” said Dr. Efstathiou. “We still did not see any detrimental effect of hormone therapy in terms of increased risk of cardiac death.”
Dr. Efstathiou said that he thinks the study will add to the debate regarding the use of ADT and potential risk of cardiac mortality.
“I think that oncologists always have to weigh the potential risks and benefits of therapies that they give, and have informed decision-making discussions with their patients as to the pros and cons based on evidence and based on data,” he said.
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“This study offers more evidence to inform that discussion: namely that there is a survival benefit with the use of hormone therapy in intermediate-risk disease, and that concerns of dying due to cardiac causes should be somewhat relieved given that this does not appear to be the case.”
Editorial: Is ADT Always Necessary?
In an accompanying editorial, Ronald Chen, MD, MPH, of the Department of Radiation Oncology, University of North Carolina at Chapel Hill, raised the issue of whether RT alone might be sufficient in cases of favorable intermediate-risk prostate cancer.3 In response, Efstathiou and his colleagues performed additional analyses to determine whether RT with ADT provided survival benefit in these cases. They found that it did.
“We did additional analyses and still saw overall disease-specific survival benefit for hormone therapy in favorable as well as unfavorable intermediate-risk disease, as well as no risk of cardiac death,” said Efstathiou.
- Voog JC, Paulus R, Shipley WU, et al. Cardiovascular mortality following short-term androgen deprivation in clinically localized prostate cancer: an analysis of RTOG 94-08. [published online ahead of print September 8, 2015]. Eur Urol. doi: 10.1016/j.eururo.2015.08.027.
- Levine GN, D’Amico AV, Berger P, et al. Androgen-deprivation therapy in prostate cancer and cardiovascular risk: a science advisory from the American Heart Association, American Cancer Society, and American Urological Association: endorsed by the American Society for Radiation Oncology. CA Cancer J Clin. 2010; 60(3):194–201.
- Chen R. Decisions regarding whether to use androgen deprivation therapy with radiotherapy in prostate cancer: is cardiovascular mortality the most relevant outcome? [published online ahead of print September 20, 2015]. Eur Urol. doi: 10.1016/j.eururo.2015.09.006.