Adding ADT to radiation therapy may carry increased cardiovascular risk


Some recent randomized clinical trials have shown that adding androgen deprivation therapy (ADT) to radiation therapy can improve outcomes in some circumstances. However, a new study from Memorial Sloan-Kettering Cancer Center (MSKCC) suggests that its use may require caution in some patients.

Kohutek et al. retrospectively analyzed the records of 2,211 MSKCC patients treated with radiation therapy from 1998 to 2008. Almost half (45 percent) received adjuvant ADT with their radiation for a median of 6.1 months. Some of the men (17 percent) received salvage ADT after radiation failure. They found:

  • Incidence of cardiovascular events (CEs) was significantly higher among men who received the adjuvant ADT (20 percent) compared to those who didn’t (14 percent).
  • The following risk factors were associated with CEs: adjuvant ADT, salvage ADT, older age, smoking, diabetes, and previous history of CE. Those factors predict CE with 81 percent accuracy.

We should use a bit of caution in interpreting these findings. First, this was a retrospective analysis and not a randomized clinical trial, so it is entirely possible that the men selected to receive adjuvant ADT were also more prone to CEs for other reasons. Also, CEs increase with age, but so does the incidence of more aggressive prostate cancer, so it is hard to separate cause and effect here. Finally, the increase in risk from 14 to 20 percent, while statistically significant, may not be clinically meaningful enough to forgo adjuvant treatment.

The New Prostate Cancer Infolink has recently reported on cardiovascular risk associated with ADT in the Swedish registry, and in the SEER database. Just as with those studies, and many more reported on this site, this one does not constitute proof, but it does suggest caution until such time as a clear link is proven or disproven. In particular, we have no proof of oncological benefit of adding ADT to radiation treatment of favorable risk prostate cancer, or when the radiation is hypofractionated. Patients should be clearly apprised of the risk and be alert for early symptoms.

Editorial note: This commentary was written for The “New” Prostate Cancer InfoLink by Allen Edel.

 

 

2 Responses

  1. I can attest to the benefits of adding ADT to radiation therapy. In 2004 at the age of 75, I was diagnosed with Gleason 9 localized prostate cancer. I received 38 treatments of external radiation (IMRT) plus 2 years of ADT. My PSA went down to approximately 0.20 and has stayed there ever since. Needless to say, I am very pleased with the result.

  2. I can affirm the value of adding ADT to radiation therapy. In 2004 at the age of 75, I was diagnosed with Gleason 9 localized prostate cancer. I received 38 sessions of external radiation (IMRT) plus 2 years of ADT. My PSA went down to about 0.20 and has stayed there since. Needless to say, I am very pleased with the outcome.

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