Prolonged Hormone Therapy Exposure Increases Risk of Diabetes and Cardiovascular Disease in Older Patients With Prostate Cancer
Although androgen deprivation therapy extends survival in men with prostate cancer, its use is associated with unwanted side effects. In addition to the well-known side effects of impaired sexual function and hot flashes, prolonged exposure to androgen deprivation therapy can also lead to diabetes and cardiovascular disease. The question is, which patients are at risk for these adverse events?
A new study presented at the 2014 Genitourinary Cancers Symposium found that over a 15-year period, the odds of developing diabetes and/or cardiovascular disease were greater in older men treated with more than 2 years of androgen deprivation therapy, especially in men with comorbidities, while younger men had no increased risk of developing diabetes or cardiovascular disease even with prolonged androgen deprivation therapy (Abstract 31).
“Our study suggests that younger men diagnosed with prostate cancer do not need to worry about diabetes or cardiovascular disease related to androgen deprivation therapy. However, for older men with comorbidities, the risk is higher. If these men have other treatment options, they may want to opt against androgen deprivation therapy,” said lead author Alicia K. Morgans, MD, of Vanderbilt-Ingram Cancer Center, Nashville.
Study Details
The study was conducted to assess the association between duration of exposure to androgen deprivation therapy and development of incident diabetes or cardiovascular disease in a prospectively surveyed cohort of 3,718 prostate cancer survivors diagnosed with local nonmetastatic disease and enrolled in the Prostate Cancer Outcomes Study.
Of these, 3,526 were eligible for the study: 2,985 for the diabetes analysis and 3,112 for the cardiovascular disease analysis.
Patients were categorized according to exposure to androgen deprivation therapy: no androgen deprivation therapy (2,033 in the diabetes analysis and 2,112 in the cardiovascular disease analysis); androgen deprivation therapy for less than 2 years (692 in the diabetes analysis and 723 in the cardiovascular disease analysis); or androgen deprivation therapy for 2 years or more (260 and 277, respectively). Development of diabetes or cardiovascular disease was measured by patient report in surveys at baseline, 6 months, and 1, 2, 5, and 15-year time points, as well as death certificate diagnoses.
Increased Risk With Prolonged Exposure, Older Age
Older men (over 76 years for diabetes and over 74 years for cardiovascular disease) who had prolonged exposure to androgen deprivation therapy (over 2 years) were at increased risk for developing these conditions. Multivariate analysis showed that men with greater comorbid disease burden had significantly increased odds of developing either condition compared with men with prostate cancer who had no other comorbidities.
Perhaps reassuring to men treated with short-term androgen deprivation therapy, less than 2 years of exposure was not associated with increased odds of developing diabetes or cardiovascular disease over a 15-year follow-up.
“We know that androgen deprivation therapy carries the risk of diabetes and cardiovascular disease, and this study says we should be monitoring for these effects in older men with comorbidities,” Dr. Morgans commented.
The study authors reported no potential conflicts of interests.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
