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Open AccessArticle

Influence of Baseline Cardiovascular Comorbidities on Mortality after Androgen Deprivation Therapy for Metastatic Prostate Cancer

1
Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
2
Division of Radiation Oncology, Department of Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
3
Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan 265, Taiwan
4
Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413, Taiwan
5
Department of Nursing, Mackay Medical College, New Taipei City 252, Taiwan
6
Department, Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan
7
Department of Urology, Wan Fang Hospital, Taipei Medical University, Taipei 106, Taiwan
8
Department of Urology, School of Medicine, Taipei Medical University, Taipei 110, Taiwan
9
Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei 110, Taiwan
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(1), 189; https://doi.org/10.3390/cancers12010189
Received: 1 November 2019 / Revised: 7 January 2020 / Accepted: 10 January 2020 / Published: 12 January 2020
(This article belongs to the Special Issue New Therapies for Prostate Cancer)
Few studies have assessed the benefits of androgen deprivation therapy (ADT) in men with metastatic prostate cancer (PC; mPC) at an old age or with major cardiovascular conditions. A retrospective cohort consisted of 3835 men with newly diagnosed mPC from the Taiwan Cancer Registry of 2008–2014. Among them, 2692 patients received only ADT in the first year after the cancer diagnosis, and 1143 patients were on watchful waiting. The inverse probability of treatment-weighted Cox model was used to estimate the effects of ADT on all-cause mortality and PC-specific mortality according to age, and the status of congestive heart failure (CHF), coronary arterial diseases (CADs), and stroke at the baseline. After a median follow-up of 2.65 years, 1650 men had died. ADT was associated with a 17–22% risk reduction in all-cause and PC-specific mortality in men without stroke, CAD, or CHF in the 65–79-year group. The survival benefit diminished in men with any of these preexisting conditions. In contrast, ADT was not found to be associated with any survival benefit in the ≥80-year group, even though they did not present with any major cardiovascular disease at the baseline. Patients who had CHF, CAD, or stroke at the baseline did not show a survival benefit following ADT in any of the age groups. Men who have preexisting major cardiovascular diseases or are ≥80 years do not demonstrate a survival benefit from ADT for mPC. The risk–benefit ratio should be considered when using ADT for mPC in older men especially those with major cardiovascular comorbidities. View Full-Text
Keywords: prostate cancer; androgen deprivation therapy; survival; cardiovascular diseases; age prostate cancer; androgen deprivation therapy; survival; cardiovascular diseases; age
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Wu, S.-Y.; Fang, S.-C.; Hwang, O.R.; Shih, H.-J.; Shao, Y.-H.J. Influence of Baseline Cardiovascular Comorbidities on Mortality after Androgen Deprivation Therapy for Metastatic Prostate Cancer. Cancers 2020, 12, 189.

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