Originally published as JCO Early Release 10.1200/JCO.2007.12.3752 on December 1 2008

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Efstathiou, J. A. Articles by Smith, M. R. Search for Related Content PubMed PubMed Citation Articles by Efstathiou, J. A. Articles by Smith, M. R. Related Articles Related Article Social Bookmarking                            What's this?

Cardiovascular Mortality After Androgen Deprivation Therapy for Locally Advanced Prostate Cancer: RTOG 85-31

Jason A. Efstathiou, Kyounghwa Bae, William U. Shipley, Gerald E. Hanks, Miljenko V. Pilepich, Howard M. Sandler, Matthew R. Smith

From the Department of Radiation Oncology and Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA; Department of Statistics, Radiation Therapy Oncology Group; Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA; Department of Radiation Oncology, University of California, Los Angeles School of Medicine, Los Angeles, CA; and Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, MI

Corresponding author: Matthew R. Smith, MD, PhD, Massachusetts General Hospital, Yawkey 7038, 55 Fruit St, Boston, MA 02114; e-mail: smith.matthew{at}mgh.harvard.edu

Purpose Gonadotropin-releasing hormone (GnRH) agonists are associated with greater risk of coronary heart disease and myocardial infarction in men with prostate cancer, but little is known about potential impact on cardiovascular mortality. We assessed the relationship between GnRH agonists and cardiovascular mortality in a large randomized phase III trial of men treated with or without adjuvant goserelin after radiation therapy (RT) for locally advanced prostate cancer.

Patients and Methods Between 1987 and 1992, 945 men with locally advanced prostate cancer were randomly assigned to RT and adjuvant goserelin or RT alone. Fine and Gray's regression was used to evaluate treatment effect on cardiovascular mortality. Covariates included age, prevalent cardiovascular disease (CVD), hypertension, diabetes mellitus (DM), body mass index, race, Gleason score, stage, acid phosphatase level, prostatectomy history, and nodal involvement.

Results After a median follow-up of 8.1 years, there were 117 cardiovascular-related deaths but no treatment-related increase in cardiovascular mortality. At 9 years, cardiovascular mortality for men receiving adjuvant goserelin was 8.4% v 11.4% for men treated without adjuvant goserelin (Gray's P = .17). In multiple regression analyses, treatment arm was not significantly associated with increased risk of cardiovascular mortality (adjusted hazard ratio [HR] = 0.73; 95% CI, 0.47 to 1.15; P = .16; when censoring at time of salvage goserelin therapy, HR = 0.99; 95% CI, 0.58 to 1.69; P = .97). Traditional cardiac risk factors, including prevalent CVD and DM, were significantly associated with greater cardiovascular mortality.

Conclusion GnRH agonists do not seem to increase cardiovascular mortality in men with locally advanced prostate cancer. Further studies are warranted to evaluate adverse effects of GnRH agonists in men with lower cancer-specific mortality.

published online ahead of print at www.jco.org on December 1, 2008.

Supported in part by an NIH K24 Midcareer Investigator Award (5K24CA121990-02; M.R.S.) and grants from the Prostate Cancer Foundation (M.R.S.).

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

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Article

• Role of Androgen Deprivation Therapy for Node-Positive Prostate Cancer
  Yu-Ning Wong, Stephen Freedland, Brian Egleston, Gary Hudes, J. Sanford Schwartz, and Katrina Armstrong
  JCO 2009 27: 100-105 [Abstract] [Full Text]

This article has been cited by other articles:

				S. M.H. Alibhai, M. Duong-Hua, R. Sutradhar, N. E. Fleshner, P. Warde, A. M. Cheung, and L. F. Paszat Impact of Androgen Deprivation Therapy on Cardiovascular Disease and Diabetes J. Clin. Oncol., July 20, 2009; 27(21): 3452 - 3458. [Abstract] [Full Text] [PDF]

				P. Boyle and O. W. Brawley Prostate Cancer: Current Evidence Weighs Against Population Screening CA Cancer J Clin, July 1, 2009; 59(4): 220 - 224. [Full Text] [PDF]

				P. J. Saylor and M. R. Smith Prostate Cancer Survivorship: Metabolic Complications of Androgen Deprivation Therapy ASCO Educational Book, January 1, 2009; 2009(1): 263 - 268. [Abstract] [Full Text] [PDF]