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Influence of Androgen Suppression Therapy for Prostate Cancer on the Frequency and Timing of Fatal Myocardial Infarctions

Anthony V. D'Amico, James W. Denham, Juanita Crook, Ming-Hui Chen, Samuel Z. Goldhaber, David S. Lamb, David Joseph, Keen-Hun Tai, Shawn Malone, Charles Ludgate, Allison Steigler, Philip W. Kantoff

From the Departments of Radiation Oncology and Medicine, Cardiovascular Division, Brigham and Women's Hospital and Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA; Departments of Radiation Oncology and Statistics, University of Connecticut, Storrs, CT; Trans-Tasman Radiation Oncology Group, Newcastle Mater Hospital, Newcastle, New South Wales; Department of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia; Princess Margaret Hospital, Toronto, Ontario; Department of Radiation Oncology, Ottawa Regional Cancer Center, Ottawa, Ontario; Department of Radiation Oncology, Vancouver Island Cancer Center, Victoria, British Columbia, Canada; and Department of Radiation Oncology, Wellington Hospital, Wellington, New Zealand

Address reprint requests to Anthony V. D'Amico, MD, PhD, Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St, L-2 Level, Boston, MA 02215; e-mail: adamico{at}lroc.harvard.edu

Purpose We evaluated whether the timing of fatal myocardial infarction (MI) was influenced by the administration of androgen suppression therapy (AST).

Patients and Methods The study cohort comprised 1,372 men who were enrolled onto three randomized trials between February 1995 and June 2001. In the three trials, the men were randomly assigned to receive radiation therapy with 0 versus 3 versus 6, 3 versus 8, or 0 versus 6 months of AST. Fine and Gray's regression was used to determine the clinical factors associated with the time to fatal MI, and estimates of time to fatal MI were calculated using a cumulative incidence method. When comparing the cumulative incidence estimates using Gray's k-sample P values, increased weight was ascribed to the earlier data because recovery of testosterone is expected for most men within 2 years after short-course AST.

Results Men age 65 years or older who received 6 months of AST experienced shorter times to fatal MIs compared with men in this age group who did not receive AST (P = .017) and men younger than 65 years (P = .016). No significant difference (P = .97) was observed in the time to fatal MIs in men age 65 years or older who received 6 to 8 months of AST compared with 3 months of AST.

Conclusion The use of AST is associated with earlier onset of fatal MIs in men age 65 years or older who are treated for 6 months compared with men who are not treated with AST.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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