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ADT associated with increased risk for diabetes, CHD

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Men of any age treated for prostate cancer with gonadotropin-releasing hormone agonists, or androgen deprivation therapy, had an increased risk for diabetes and cardiovascular disease in an observational study. Specifically, the risk was increased for diabetes, myocardial infarction, stroke, sudden cardiac death and coronary heart disease.

“Although the risks associated with ADT remain incompletely defined, the potential for harm from this treatment underscores the importance of better understanding the benefits,” researchers wrote.

In the study, the researchers looked at data from 38,000 men who had been diagnosed with local or regional prostate cancer from the Veterans Healthcare Administration. Data were taken from January 2001 to December 2004; follow-up was conducted through December 2005.

The effect of ADT with GnRH agonists, oral antiandrogens, the combination of the two, or orchiectomy on risk for diabetes and CVD was assessed after adjustment for patient and tumor characteristics. Thirty-nine percent of the men on trial were treated with ADT.

There were almost twice as many occurrences of diabetes among men treated with GnRH agonists compared to men with no ADT (159.4 events per 1,000 person years vs. 87.5 events per 1,000 person years), a statistically significant difference.

These men were also at an increased adjusted risk for CHD (HR=1.19; 95% CI, 1.10-1.28), MI (HR=1.28; 95% CI, 1.08-1.52), sudden cardiac death (HR=1.35, 95% CI, 1.18-1.54), and stroke (HR=1.22, 95% CI, 1.10 to 1.36).

In an accompanying editorial, Peter Albertsen, MD, from the University of Connecticut Health Center in Farmington, said this study adds to the growing body of literature on ADT. The researchers gave a glimpse into the extent of therapy adverse effects for contemporary patients, including men aged younger than 55 years and older than 75 years, according to Albertsen.

“With the growing number of men wrestling with rising prostate-specific antigen values after treatment, we should organize appropriate trials and reflect carefully about the anticipated benefits and harm before initiating ADT treatment,” he wrote.

Keating NL. J Natl Cancer Inst. 2009;101:doi:10.1093/jnci/djp404.