Influence of age on incident diabetes and cardiovascular disease in prostate cancer survivors receiving androgen deprivation therapy

Abstract

Purpose: Observational data suggest that androgen deprivation therapy increases the risk of diabetes and cardiovascular disease. Using data from the population based PCOS we evaluated whether age at diagnosis and comorbidity impact the association of androgen deprivation therapy with incident diabetes and cardiovascular disease.

Materials and methods: We identified men with nonmetastatic prostate cancer diagnosed from 1994 to 1995 who were followed through 2009 to 2010. We used multivariable logistic regression models to assess the relationship of androgen deprivation therapy exposure (2 or fewer years, greater than 2 years or none) with incident diabetes and cardiovascular disease, adjusting for age at diagnosis, race, stage and comorbidity.

Results: Of 3,526 eligible study participants 2,985 without diabetes and 3,112 without cardiovascular disease comprised the cohorts at risk. Androgen deprivation therapy was not associated with an increased risk of diabetes or cardiovascular disease in men diagnosed with prostate cancer before age 70 years. Prolonged androgen deprivation therapy and increasing age at diagnosis in older men was associated with an increased risk of diabetes (at age 76 years OR 2.1, 95% CI 1.0-4.4) and cardiovascular disease (at age 74 years OR 1.9, 95% CI 1.0-3.5). Men with comorbidities were at greater risk for diabetes (OR 4.3, 95% CI 2.3-7.9) and cardiovascular disease (OR 8.1, 95% CI 4.3-15.5) than men without comorbidities.

Conclusions: Prolonged androgen deprivation therapy exposure increases the risk of cardiovascular disease and diabetes in men diagnosed with prostate cancer who are older than approximately 75 years, especially those with other comorbidities. Older men who receive prolonged androgen deprivation therapy should be closely monitored for diabetes and cardiovascular disease.

Keywords: antiandrogens; cardiovascular diseases; diabetes mellitus; prostatic neoplasms; risk.

Figure 1

CONSORT diagram of PCOS participants included in DM and CVD analyses

Figure 2

Odds of DM by age at diagnosis of prostate cancer and ADT exposure. Solid curve indicates odds of DM. Dashed curves indicate 95% CI.

Figure 3

Odds of CVD by age at diagnosis of prostate cancer and ADT exposure. Solid curve indicates odds of CVD. Dashed curves indicate 95% CI.