Risks of Serious Toxicities from Intermittent versus Continuous Androgen Deprivation Therapy for Advanced Prostate Cancer: A Population Based Study

No AccessJournal of UrologyAdult Urology1 May 2017Risks of Serious Toxicities from Intermittent versus Continuous Androgen Deprivation Therapy for Advanced Prostate Cancer: A Population Based Study Huei-Ting Tsai, Ruth M. Pfeiffer, George K. Philips, Ana Barac, Alex Z. Fu, David F. Penson, Yingjun Zhou, and Arnold L. Potosky Huei-Ting TsaiHuei-Ting Tsai Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author , Ruth M. PfeifferRuth M. Pfeiffer National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author , George K. PhilipsGeorge K. Philips Department of Medicine, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author , Ana BaracAna Barac Division of Cardiology, MedStar Washington Hospital Center, Washington, D.C. More articles by this author , Alex Z. FuAlex Z. Fu Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author , David F. PensonDavid F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author , Yingjun ZhouYingjun Zhou Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author , and Arnold L. PotoskyArnold L. Potosky Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.12.022AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Randomized trials have shown that intermittent androgen deprivation therapy for patients with advanced prostate cancer may improve sexual and physical functioning compared to continuous androgen deprivation therapy without compromising survival. To our knowledge it is unknown whether intermittent androgen deprivation therapy alters the risk of serious toxicities associated with continuous androgen deprivation therapy. Materials and Methods: We performed a population based cohort study of 9,772 men 66 years old or older who were diagnosed with advanced prostate cancer from 2002 to 2011 and treated with androgen deprivation therapy. Intermittent androgen deprivation therapy was defined as a single 90-day interval between 2 androgen deprivation therapy sessions during which patients visited their physicians or underwent prostate specific antigen testing. Outcomes included acute myocardial infarction, stroke, heart failure, type 2 diabetes and fracture. We used Cox proportional hazard models to estimate the HRs of the comparative risk of serious toxicities between intermittent and continuous androgen deprivation therapy. Results: A total of 2,113 (22%), 769 (9%) and 899 men (9%) had a new cardiovascular event, diabetes or fracture, respectively, within 5 years of starting androgen deprivation therapy. Compared to the continuous androgen deprivation therapy group, the intermittent therapy group was at lower risk for serious cardiovascular events (HR 0.64, 95% CI 0.53–0.77), particularly in reducing the risk of heart failure (HR 0.62, 95% CI 0.49–0.78) and fracture (HR 0.52, 95% CI 0.38–0.70, each p <0.0001). Conclusions: Intermittent androgen deprivation therapy was associated with a lower risk of heart failure and fracture compared to continuous androgen deprivation therapy. This raises toxicity concerns for continuous relative to intermittent therapy and suggests that intermittent androgen deprivation therapy may represent a safer therapeutic choice in elderly men with advanced prostate cancer. References 1 : Androgen suppression strategies for prostate cancer: is there an ideal approach?. Curr Urol Rep2011; 12: 188. Google Scholar 2 : Intermittent androgen deprivation for patients with recurrent/metastatic prostate cancer. Am J Clin Oncol2003; 26: e119. Google Scholar 3 : Treatment strategies for high-risk locally advanced prostate cancer. Nat Rev Urol2010; 7: 31. Google Scholar 4 : Impact of androgen deprivation therapy on cardiovascular disease and diabetes. J Clin Oncol2009; 27: 3452. 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Volume 197Issue 5May 2017Page: 1251-1257Supplementary Materials Advertisement Copyright & Permissions© 2017 by American Urological Association Education and Research, Inc.Keywordshormonalantineoplastic agentsandrogen antagonistsprostatic neoplasmsriskdrug related side effects and adverse reactionsAcknowledgmentsTania Lobo assisted with data management. Charlene Kuo assisted with the manuscript.MetricsAuthor Information Huei-Ting Tsai Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author Ruth M. Pfeiffer National Cancer Institute, National Institutes of Health, Bethesda, Maryland More articles by this author George K. Philips Department of Medicine, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author Ana Barac Division of Cardiology, MedStar Washington Hospital Center, Washington, D.C. More articles by this author Alex Z. Fu Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author David F. Penson Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee More articles by this author Yingjun Zhou Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author Arnold L. Potosky Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Georgetown University, Washington, D.C. More articles by this author Expand All Advertisement PDF downloadLoading ...