Diabetes And Cardiovascular Disease During Androgen Deprivation Therapy For Prostate Cancer

UroToday.com - While recent data have raised awareness regarding the association between the metabolic syndrome and androgen deprivation therapy for prostate cancer, the exact risk of diabetes mellitus and cardiovascular disease in these patients has not been well established.

In the September 20th issue of the JCO, Keating and colleagues from the Department of Health Policy of Harvard Medical School report on an observational study of nearly 74,000 Medicare patients treated for prostate cancer over a 7 year-period (1992 - 1999). Patients were observed until 2001 to assess whether use of LHRH agonists or orchiectomy was associated with diabetes, coronary artery disease, myocardial infarction, or sudden death.

Of the 73,196 men studied, over one-third received therapy with LHRH agonists at some point during their follow-up. After adjusting for confounding variables, these patients exhibited an increased risk for coronary heart disease (adjusted hazard ratio 1.16, p < 0.001), diabetes mellitus (HR = 1.44, p < 0.001), myocardial infarction (HR 1.11, p < 0.04), and sudden cardiac death (HR 1.34, p < 0.001). Patients who underwent bilateral orchiectomy demonstrated an increased risk for diabetes (HR 1.34, p < 0.001) but for none of the other factors studied.

These epidemiological data add to the mounting evidence that androgen deprivation therapy may be associated with an increased risk of developing the metabolic syndrome. Clearly as urologists we must take a leadership role in involving our internal medicine colleagues early to emphasize prevention. The fact that orchiectomy was not associated with an increased risk of coronary heart disease (compared with LHRH agonist therapy) deserves validation and further study.

Nancy L. Keating, A. James O'Malley, and Matthew R. Smith

J Clin Oncol. 2006 Sep 20;24(27):4448-56
Reviewed By UroToday.com Contributing Editor Ricardo Sanchez-Ortiz, MD

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