Steven E. Canfield, MD; Philipp Dahm, MD, MHSc, FACS
In men with unfavorable-risk, nonmetastatic prostate cancer, does androgen deprivation therapy (ADT) increase cardiovascular (CV) mortality?
Included studies compared immediate ADT, predominantly with a gonadotropin-releasing hormone (GnRH) agonist, with no immediate ADT (control), in patients with nonmetastatic and non–hormone refractory prostate cancer. Outcomes were CV, prostate cancer, and all-cause mortality.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (all to Apr 2011) were searched for English-language, randomized, controlled trials (RCTs) that provided adequate data on the outcomes of interest and had a median follow-up ≥ 1 year. 11 RCTs (n = 4805) met the selection criteria (median age 61 to 73 y). All were open-label, multicenter, phase 3 trials.
Meta-analysis showed that ADT and control groups did not differ for CV mortality (Table). ADT decreased prostate cancer mortality and all-cause mortality (Table).
In men with unfavorable-risk, nonmetastatic prostate cancer, androgen deprivation therapy does not increase risk for cardiovascular mortality and decreases risk for prostate cancer mortality and all-cause mortality.
Androgen deprivation therapy (ADT) vs control in unfavorable-risk, nonmetastatic prostate cancer*
*CV = cardiovascular; other abbreviations defined in Glossary. ADT event rates, RRR, NNT, and CI calculated from control event rates and relative risks in article.
Canfield SE, Dahm P. Review: Androgen deprivation therapy does not increase CV mortality in prostate cancer. Ann Intern Med. ;156:JC4–4. doi: 10.7326/0003-4819-156-8-201204170-02004
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Published: Ann Intern Med. 2012;156(8):JC4-4.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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