The risk of cardiovascular (CV) ischemic events may be increased among patients with prostate cancer (PCa) who receive androgen-deprivation therapy (ADT) by bilateral orchiectomy compared with patients who receive gonadotropin-releasing hormone agonist (GnRHa) therapy, according to data published in the Journal of Clinical Oncology.1

Recent evidence suggests that ADT may increase the risk of CV ischemic events such as myocardial infarction (MI) and ischemic stroke (IS), but the current data are inadequate for demonstrating whether bilateral orchiectomy or GnRHa has worse long-term outcomes.

For this study, researchers identified 14,715 men with PCa from the Taiwan National Health Insurance Research Database, of whom 24.3% underwent bilateral orchiectomies and 75.7% received GnRHa therapy. The mean age at baseline was 75.4 years, and patients treated with GnRHa were younger and had a greater number of distant metastases.

During the first 1.5 years of follow-up, patients who had undergone orchiectomy experienced a greater number of CV ischemic events compared with patients who received GnRHa (hazard ratio [HR], 1.40; 95% CI, 1.04-1.88). The effect was more pronounced in patients who were 65 years or older, were hypertensive, had a history of MI, IS, or coronary heart disease, and had a score of 3 or greater on the Charlson comorbidity index score.

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At median follow-up of 3.3 years, both groups had similar risk of CV ischemic events (HR, 1.16; 95% CI, 0.97-1.38).

The data suggest that CV risk is not significantly different between patients who receive orchiectomies or GnRHa, and the authors concluded that the findings provide “reassurance when considering GnRHA for the method of ADT in patients in PCa.”

Reference

  1. Chen DY, See LC, Liu JR, et al. Risk of cardiovascular ischemic events after surgical castration and gonadotropin-releasing hormone agonist therapy for prostate cancer: a nationwide cohort study. J Clin Oncol. 2017 Oct 2. doi: 10.1200/JCO.2016.71.4204 [Epub ahead of print]