ANDROGEN DEPRIVATION THERAPY AND CARDIOVASCULAR RISK IN PATIENTS WITH PROSTATE CANCER

Risk in Patients With Prostate Cancer

Abstract

Objective: The objective of this study was to investigate the effects of androgen deprivation therapy (ADT) on risk of subsequent cardiovascular morbidity in men with prostate cancer.
Study Design: Quasi experimental study.
Place and Duration of Study: Department of oncology Combined Military Hospital Rawalpindi, from Sep 2014 to May 2015.
Patients and Methods: Thirty consecutive patients fulfilling inclusion criteria were enrolled. All patients were subjected to medical castration/ androgen deprivation therapy (ADT) with monthly 3.75 mg leuprorelin acetate intramuscular injection until castrate levels of testosterone (<50ng/dL) were achieved. We used Framingham’s score for assessment of 10 years cardiovascular risk of individual patient before initiation and after completion of 6 months ADT. Serum lipid profile (fasting), systolic blood pressure, history of smoking, diabetes and antihypertensive medication were recorded. Proforma was designed to get clinical information. A p-value of <0.05 was considered significant. A paired-samples t-test was conducted to compare Framingham cardiovascular risk scores before initiation and after completion of 6 months ADT.
Results: We enrolled 30 men with high/intermediate risk localized prostate cancer. Mean age was 63.47 ± 7.32 years. All patients received 6 months ADT with monthly 3.75mg leuprorelin acetate intramuscular injection. There was a significant difference in Framingham cardiovascular risk scores before (mean ± sd; 20.95 ± 7.98) and after (mean ± sd; 25.72 ± 6.15) 6 months ADT; t (29) =−4.54, p<0.01, two-tailed. Hence ADT resulted in a significant increase (mean ± sd; 25.7 ± 6.15) in 10 years cardiovascular morbidity risk t (29) =−4.54, p<0.01, twotailed. Subset analyses revealed significant increase in fasting serum total cholesterol, triglycerides and Lowdensity lipoprotein (LDL) levels after 6 months ADT (p<0.01, <0.01 and <0.01 respectively) however high density lipoprotein (HDL) remained un-changed (p=0.043) in comparison to pre-ADT values.
Conclusion: Androgen deprivation therapy results in significantly increased risk of cardiovascular morbidity in patients with prostate cancer however this relationship between ADT and risk of cardiovascular morbidity may be confounded by unmeasured variables like obesity, atherosclerosis and body mass index (BMI) variations.