Cardiovascular Mortality and Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-term Update of NRG/RTOG 9202
With 19.6 yr of follow-up, RTOG 9202 revealed that 28 mo of androgen deprivation therapy (ADT) did not increase cardiovascular mortality versus 4 mo of ADT. For men with baseline cardiovascular disease, longer-term ADT may be associated with increased myocardial infarction mortality. Androgen depriv...
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| Veröffentlicht in: | European urology focus 2024-03, Vol.10 (2), p.271-278 |
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| creator | Mak, Kimberley S. Scannell Bryan, Molly Dignam, James J. Shipley, William U. Lin, Yue Peters, Christopher A. Gore, Elizabeth M. Rosenthal, Seth A. Zeitzer, Kenneth L. D'Souza, David P. Horwitz, Eric M. Pisansky, Thomas M. Maier, Jordan M. Chafe, Susan M. Robin, Tyler P. Roach, Mack Tran, Phuoc T. Souhami, Luis Michalski, Jeff M. Hartford, Alan C. Feng, Felix Y. Sandler, Howard M. Efstathiou, Jason A. |
| description | With 19.6 yr of follow-up, RTOG 9202 revealed that 28 mo of androgen deprivation therapy (ADT) did not increase cardiovascular mortality versus 4 mo of ADT. For men with baseline cardiovascular disease, longer-term ADT may be associated with increased myocardial infarction mortality.
Androgen deprivation therapy (ADT) has been associated with coronary heart disease and myocardial infarction (MI) in prostate cancer patients, but controversy persists regarding its effects on cardiovascular mortality (CVM).
We assessed the long-term relationship between ADT and CVM in a prostate cancer randomized trial (NRG Oncology/Radiation Therapy Oncology Group 9202).
From 1992 to 1995, 1554 men with locally advanced prostate cancer (T2c–T4, prostate-specific antigen |
| doi_str_mv | 10.1016/j.euf.2024.01.008 |
| format | Article |
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Androgen deprivation therapy (ADT) has been associated with coronary heart disease and myocardial infarction (MI) in prostate cancer patients, but controversy persists regarding its effects on cardiovascular mortality (CVM).
We assessed the long-term relationship between ADT and CVM in a prostate cancer randomized trial (NRG Oncology/Radiation Therapy Oncology Group 9202).
From 1992 to 1995, 1554 men with locally advanced prostate cancer (T2c–T4, prostate-specific antigen <150 ng/ml) received radiotherapy with 4 mo (short-term [STADT]) versus 28 mo (longer-term [LTADT]) of ADT.
Using the Fine-Gray and Cox regression models, the relationship between ADT and mortality was evaluated.
With a median follow-up of 19.6 yr, LTADT was associated with improved overall survival (OS) versus STADT (adjusted hazard ratio [HR] 0.88; p = 0.03) and prostate cancer survival (subdistribution HR [sHR] 0.70, p = 0.003). Comparing LTADT with STADT, prostate cancer mortality improved by 6.0% (15.6% [95% confidence interval 13.0–18.3%] vs 21.6% [18.6–24.7%]) at 15 yr, while CVM increased by 2.2% (14.9% [12.4–17.6%] vs 12.7% [10.4–15.3%]). In multivariable analyses, LTADT was not associated with increased CVM versus STADT (sHR 1.22 [0.93–1.59]; p = 0.15). An association between LTADT and MI death was detected (sHR 1.58 [1.00–2.50]; p = 0.05), particularly in patients with prevalent cardiovascular disease (CVD; sHR 2.54 [1.16–5.58]; p = 0.02).
With 19.6 yr of follow-up, LTADT was not significantly associated with increased CVM in men with locally advanced prostate cancer. Patients may have increased MI mortality with LTADT, particularly those with baseline CVD. Overall, there remained a prostate cancer mortality benefit and no OS detriment with LTADT.
In a long-term analysis of a large randomized prostate cancer trial, radiation with 28 mo of hormone therapy did not increase the risk of cardiovascular death significantly versus 4 mo of hormone therapy. Future studies are needed for patients with pre-existing heart disease, who may have an increased risk of myocardial infarction death with longer hormone use.</description><identifier>ISSN: 2405-4569</identifier><identifier>EISSN: 2405-4569</identifier><identifier>DOI: 10.1016/j.euf.2024.01.008</identifier><identifier>PMID: 38307806</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Aged ; Androgen Antagonists - therapeutic use ; Androgen deprivation therapy ; Cardiovascular Diseases - mortality ; Cardiovascular mortality ; Follow-Up Studies ; Hormonal therapy ; Humans ; Male ; Middle Aged ; Proportional Hazards Models ; Prostate cancer ; Prostatic Neoplasms - mortality ; Prostatic Neoplasms - pathology ; Radiation therapy ; Time Factors</subject><ispartof>European urology focus, 2024-03, Vol.10 (2), p.271-278</ispartof><rights>2024 European Association of Urology</rights><rights>Copyright © 2024 European Association of Urology. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c305t-59578887ceab823b8ecdb7367f79080f7db58af73df31ba53a63ada01df5f2593</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38307806$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mak, Kimberley S.</creatorcontrib><creatorcontrib>Scannell Bryan, Molly</creatorcontrib><creatorcontrib>Dignam, James J.</creatorcontrib><creatorcontrib>Shipley, William U.</creatorcontrib><creatorcontrib>Lin, Yue</creatorcontrib><creatorcontrib>Peters, Christopher A.</creatorcontrib><creatorcontrib>Gore, Elizabeth M.</creatorcontrib><creatorcontrib>Rosenthal, Seth A.</creatorcontrib><creatorcontrib>Zeitzer, Kenneth L.</creatorcontrib><creatorcontrib>D'Souza, David P.</creatorcontrib><creatorcontrib>Horwitz, Eric M.</creatorcontrib><creatorcontrib>Pisansky, Thomas M.</creatorcontrib><creatorcontrib>Maier, Jordan M.</creatorcontrib><creatorcontrib>Chafe, Susan M.</creatorcontrib><creatorcontrib>Robin, Tyler P.</creatorcontrib><creatorcontrib>Roach, Mack</creatorcontrib><creatorcontrib>Tran, Phuoc T.</creatorcontrib><creatorcontrib>Souhami, Luis</creatorcontrib><creatorcontrib>Michalski, Jeff M.</creatorcontrib><creatorcontrib>Hartford, Alan C.</creatorcontrib><creatorcontrib>Feng, Felix Y.</creatorcontrib><creatorcontrib>Sandler, Howard M.</creatorcontrib><creatorcontrib>Efstathiou, Jason A.</creatorcontrib><title>Cardiovascular Mortality and Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-term Update of NRG/RTOG 9202</title><title>European urology focus</title><addtitle>Eur Urol Focus</addtitle><description>With 19.6 yr of follow-up, RTOG 9202 revealed that 28 mo of androgen deprivation therapy (ADT) did not increase cardiovascular mortality versus 4 mo of ADT. For men with baseline cardiovascular disease, longer-term ADT may be associated with increased myocardial infarction mortality.
Androgen deprivation therapy (ADT) has been associated with coronary heart disease and myocardial infarction (MI) in prostate cancer patients, but controversy persists regarding its effects on cardiovascular mortality (CVM).
We assessed the long-term relationship between ADT and CVM in a prostate cancer randomized trial (NRG Oncology/Radiation Therapy Oncology Group 9202).
From 1992 to 1995, 1554 men with locally advanced prostate cancer (T2c–T4, prostate-specific antigen <150 ng/ml) received radiotherapy with 4 mo (short-term [STADT]) versus 28 mo (longer-term [LTADT]) of ADT.
Using the Fine-Gray and Cox regression models, the relationship between ADT and mortality was evaluated.
With a median follow-up of 19.6 yr, LTADT was associated with improved overall survival (OS) versus STADT (adjusted hazard ratio [HR] 0.88; p = 0.03) and prostate cancer survival (subdistribution HR [sHR] 0.70, p = 0.003). Comparing LTADT with STADT, prostate cancer mortality improved by 6.0% (15.6% [95% confidence interval 13.0–18.3%] vs 21.6% [18.6–24.7%]) at 15 yr, while CVM increased by 2.2% (14.9% [12.4–17.6%] vs 12.7% [10.4–15.3%]). In multivariable analyses, LTADT was not associated with increased CVM versus STADT (sHR 1.22 [0.93–1.59]; p = 0.15). An association between LTADT and MI death was detected (sHR 1.58 [1.00–2.50]; p = 0.05), particularly in patients with prevalent cardiovascular disease (CVD; sHR 2.54 [1.16–5.58]; p = 0.02).
With 19.6 yr of follow-up, LTADT was not significantly associated with increased CVM in men with locally advanced prostate cancer. Patients may have increased MI mortality with LTADT, particularly those with baseline CVD. Overall, there remained a prostate cancer mortality benefit and no OS detriment with LTADT.
In a long-term analysis of a large randomized prostate cancer trial, radiation with 28 mo of hormone therapy did not increase the risk of cardiovascular death significantly versus 4 mo of hormone therapy. Future studies are needed for patients with pre-existing heart disease, who may have an increased risk of myocardial infarction death with longer hormone use.</description><subject>Aged</subject><subject>Androgen Antagonists - therapeutic use</subject><subject>Androgen deprivation therapy</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular mortality</subject><subject>Follow-Up Studies</subject><subject>Hormonal therapy</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Proportional Hazards Models</subject><subject>Prostate cancer</subject><subject>Prostatic Neoplasms - mortality</subject><subject>Prostatic Neoplasms - pathology</subject><subject>Radiation therapy</subject><subject>Time Factors</subject><issn>2405-4569</issn><issn>2405-4569</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kM1u1DAUhSMEolXpA7BBXrJJasdxbMNqNIUBaaCoatfWjX8qjzLxYDsjzZ4Hx9EUxIqNf797pPNV1VuCG4JJf7Nr7OyaFrddg0mDsXhRXbYdZnXHevnyn_NFdZ3SDmNMWMepoK-ri7JiLnB_Wf1aQzQ-HCHpeYSIvoWYYfT5hGAy6HaOkH2YUHBoNZkYnuyEbu0h-uP53U9oGzSM4wmtzBEmbQ36EUPKkC1aL_f4oRDTU51t3KPHg1k-Str3-83N_cPdBsnS4E31ysGY7PXzflU9fv70sP5Sb-82X9erba0pZrlmknEhBNcWBtHSQVhtBk577rjEAjtuBibAcWocJQMwCj0FA5gYx1zLJL2q3p9zDzH8nG3Kau-TtuMIkw1zUq1sOyklb2lByRnVpU2K1qlSeg_xpAhWi3-1U8W_WvwrTFTxX2bePcfPw96avxN_bBfg4xmwpeTR26iS9naR5qPVWZng_xP_G_rLlaQ</recordid><startdate>20240301</startdate><enddate>20240301</enddate><creator>Mak, Kimberley S.</creator><creator>Scannell Bryan, Molly</creator><creator>Dignam, James J.</creator><creator>Shipley, William U.</creator><creator>Lin, Yue</creator><creator>Peters, Christopher A.</creator><creator>Gore, Elizabeth M.</creator><creator>Rosenthal, Seth A.</creator><creator>Zeitzer, Kenneth L.</creator><creator>D'Souza, David P.</creator><creator>Horwitz, Eric M.</creator><creator>Pisansky, Thomas M.</creator><creator>Maier, Jordan M.</creator><creator>Chafe, Susan M.</creator><creator>Robin, Tyler P.</creator><creator>Roach, Mack</creator><creator>Tran, Phuoc T.</creator><creator>Souhami, Luis</creator><creator>Michalski, Jeff M.</creator><creator>Hartford, Alan C.</creator><creator>Feng, Felix Y.</creator><creator>Sandler, Howard M.</creator><creator>Efstathiou, Jason A.</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240301</creationdate><title>Cardiovascular Mortality and Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-term Update of NRG/RTOG 9202</title><author>Mak, Kimberley S. ; Scannell Bryan, Molly ; Dignam, James J. ; Shipley, William U. ; Lin, Yue ; Peters, Christopher A. ; Gore, Elizabeth M. ; Rosenthal, Seth A. ; Zeitzer, Kenneth L. ; D'Souza, David P. ; Horwitz, Eric M. ; Pisansky, Thomas M. ; Maier, Jordan M. ; Chafe, Susan M. ; Robin, Tyler P. ; Roach, Mack ; Tran, Phuoc T. ; Souhami, Luis ; Michalski, Jeff M. ; Hartford, Alan C. ; Feng, Felix Y. ; Sandler, Howard M. ; Efstathiou, Jason A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c305t-59578887ceab823b8ecdb7367f79080f7db58af73df31ba53a63ada01df5f2593</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Aged</topic><topic>Androgen Antagonists - therapeutic use</topic><topic>Androgen deprivation therapy</topic><topic>Cardiovascular Diseases - mortality</topic><topic>Cardiovascular mortality</topic><topic>Follow-Up Studies</topic><topic>Hormonal therapy</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Proportional Hazards Models</topic><topic>Prostate cancer</topic><topic>Prostatic Neoplasms - mortality</topic><topic>Prostatic Neoplasms - pathology</topic><topic>Radiation therapy</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Mak, Kimberley S.</creatorcontrib><creatorcontrib>Scannell Bryan, Molly</creatorcontrib><creatorcontrib>Dignam, James J.</creatorcontrib><creatorcontrib>Shipley, William U.</creatorcontrib><creatorcontrib>Lin, Yue</creatorcontrib><creatorcontrib>Peters, Christopher A.</creatorcontrib><creatorcontrib>Gore, Elizabeth M.</creatorcontrib><creatorcontrib>Rosenthal, Seth A.</creatorcontrib><creatorcontrib>Zeitzer, Kenneth L.</creatorcontrib><creatorcontrib>D'Souza, David P.</creatorcontrib><creatorcontrib>Horwitz, Eric M.</creatorcontrib><creatorcontrib>Pisansky, Thomas M.</creatorcontrib><creatorcontrib>Maier, Jordan M.</creatorcontrib><creatorcontrib>Chafe, Susan M.</creatorcontrib><creatorcontrib>Robin, Tyler P.</creatorcontrib><creatorcontrib>Roach, Mack</creatorcontrib><creatorcontrib>Tran, Phuoc T.</creatorcontrib><creatorcontrib>Souhami, Luis</creatorcontrib><creatorcontrib>Michalski, Jeff M.</creatorcontrib><creatorcontrib>Hartford, Alan C.</creatorcontrib><creatorcontrib>Feng, Felix Y.</creatorcontrib><creatorcontrib>Sandler, Howard M.</creatorcontrib><creatorcontrib>Efstathiou, Jason A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European urology focus</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mak, Kimberley S.</au><au>Scannell Bryan, Molly</au><au>Dignam, James J.</au><au>Shipley, William U.</au><au>Lin, Yue</au><au>Peters, Christopher A.</au><au>Gore, Elizabeth M.</au><au>Rosenthal, Seth A.</au><au>Zeitzer, Kenneth L.</au><au>D'Souza, David P.</au><au>Horwitz, Eric M.</au><au>Pisansky, Thomas M.</au><au>Maier, Jordan M.</au><au>Chafe, Susan M.</au><au>Robin, Tyler P.</au><au>Roach, Mack</au><au>Tran, Phuoc T.</au><au>Souhami, Luis</au><au>Michalski, Jeff M.</au><au>Hartford, Alan C.</au><au>Feng, Felix Y.</au><au>Sandler, Howard M.</au><au>Efstathiou, Jason A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiovascular Mortality and Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-term Update of NRG/RTOG 9202</atitle><jtitle>European urology focus</jtitle><addtitle>Eur Urol Focus</addtitle><date>2024-03-01</date><risdate>2024</risdate><volume>10</volume><issue>2</issue><spage>271</spage><epage>278</epage><pages>271-278</pages><issn>2405-4569</issn><eissn>2405-4569</eissn><abstract>With 19.6 yr of follow-up, RTOG 9202 revealed that 28 mo of androgen deprivation therapy (ADT) did not increase cardiovascular mortality versus 4 mo of ADT. For men with baseline cardiovascular disease, longer-term ADT may be associated with increased myocardial infarction mortality.
Androgen deprivation therapy (ADT) has been associated with coronary heart disease and myocardial infarction (MI) in prostate cancer patients, but controversy persists regarding its effects on cardiovascular mortality (CVM).
We assessed the long-term relationship between ADT and CVM in a prostate cancer randomized trial (NRG Oncology/Radiation Therapy Oncology Group 9202).
From 1992 to 1995, 1554 men with locally advanced prostate cancer (T2c–T4, prostate-specific antigen <150 ng/ml) received radiotherapy with 4 mo (short-term [STADT]) versus 28 mo (longer-term [LTADT]) of ADT.
Using the Fine-Gray and Cox regression models, the relationship between ADT and mortality was evaluated.
With a median follow-up of 19.6 yr, LTADT was associated with improved overall survival (OS) versus STADT (adjusted hazard ratio [HR] 0.88; p = 0.03) and prostate cancer survival (subdistribution HR [sHR] 0.70, p = 0.003). Comparing LTADT with STADT, prostate cancer mortality improved by 6.0% (15.6% [95% confidence interval 13.0–18.3%] vs 21.6% [18.6–24.7%]) at 15 yr, while CVM increased by 2.2% (14.9% [12.4–17.6%] vs 12.7% [10.4–15.3%]). In multivariable analyses, LTADT was not associated with increased CVM versus STADT (sHR 1.22 [0.93–1.59]; p = 0.15). An association between LTADT and MI death was detected (sHR 1.58 [1.00–2.50]; p = 0.05), particularly in patients with prevalent cardiovascular disease (CVD; sHR 2.54 [1.16–5.58]; p = 0.02).
With 19.6 yr of follow-up, LTADT was not significantly associated with increased CVM in men with locally advanced prostate cancer. Patients may have increased MI mortality with LTADT, particularly those with baseline CVD. Overall, there remained a prostate cancer mortality benefit and no OS detriment with LTADT.
In a long-term analysis of a large randomized prostate cancer trial, radiation with 28 mo of hormone therapy did not increase the risk of cardiovascular death significantly versus 4 mo of hormone therapy. Future studies are needed for patients with pre-existing heart disease, who may have an increased risk of myocardial infarction death with longer hormone use.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>38307806</pmid><doi>10.1016/j.euf.2024.01.008</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
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| ispartof | European urology focus, 2024-03, Vol.10 (2), p.271-278 |
| issn | 2405-4569 2405-4569 |
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| source | MEDLINE; Alma/SFX Local Collection |
| subjects | Aged Androgen Antagonists - therapeutic use Androgen deprivation therapy Cardiovascular Diseases - mortality Cardiovascular mortality Follow-Up Studies Hormonal therapy Humans Male Middle Aged Proportional Hazards Models Prostate cancer Prostatic Neoplasms - mortality Prostatic Neoplasms - pathology Radiation therapy Time Factors |
| title | Cardiovascular Mortality and Duration of Androgen Deprivation in Locally Advanced Prostate Cancer: Long-term Update of NRG/RTOG 9202 |
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