Original Article

Androgen deprivation and thromboembolic events in men with prostate cancer†‡

  1. Behfar Ehdaie MD1,2,§,*,
  2. Coral L. Atoria MPH2,
  3. Amit Gupta MD1,
  4. Andrew Feifer MD1,
  5. William T. Lowrance MD1,
  6. Michael J. Morris MD3,
  7. Peter T. Scardino MD1,
  8. James A. Eastham MD1,
  9. Elena B. Elkin PhD2

Article first published online: 9 NOV 2011

DOI: 10.1002/cncr.26623

Issue

Cancer

Cancer

Volume 118, Issue 13, pages 3397–3406, 1 July 2012

Additional Information

How to Cite

Ehdaie, B., Atoria, C. L., Gupta, A., Feifer, A., Lowrance, W. T., Morris, M. J., Scardino, P. T., Eastham, J. A. and Elkin, E. B. (2012), Androgen deprivation and thromboembolic events in men with prostate cancer. Cancer, 118: 3397–3406. doi: 10.1002/cncr.26623

Author Information

  1. 1

    Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York

  2. 2

    Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York

  3. 3

    Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

  1. §

    Fax: (646) 735-0011

*Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065

  1. †

    The authors acknowledge the efforts of the Applied Research Program, National Cancer Institute (NCI); the Office of Research, Development and Information, Centers for Medicare and Medicaid Services; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

  2. ‡

    See editorial on pages 3232–5, this issue.

  3. §

    Fax: (646) 735-0011

Publication History

  1. Issue published online: 18 JUN 2012
  2. Article first published online: 9 NOV 2011
  3. Manuscript Accepted: 21 JUL 2011
  4. Manuscript Revised: 28 JUN 2011
  5. Manuscript Received: 5 MAY 2011

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Keywords:

  • prostate cancer;
  • deep vein thrombosis;
  • pulmonary embolism;
  • androgen deprivation;
  • arterial embolism

Abstract

BACKGROUND:

Androgen deprivation therapy (ADT) improves prostate cancer outcomes in specific clinical settings, but is associated with adverse effects, including cardiac complications and possibly thromboembolic complications. The objective of this study was to estimate the impact of ADT on thromboembolic events (TEs) in a population-based cohort.

METHODS:

In the linked Surveillance, Epidemiology and End Results–Medicare database, we identified men older than 65 who were diagnosed with nonmetastatic prostate cancer between 1999 and 2005. Medical or surgical ADT was identified by Medicare claims for gonadotropin-releasing hormone agonists or bilateral orchiectomy at any time following diagnosis. TEs included deep venous thrombosis, pulmonary embolism, and arterial embolism. The impact of ADT on the risk of any TE and on total number of events was estimated, controlling for patient and tumor characteristics.

RESULTS:

Of 154,611 patients with prostate cancer, 58,466 (38%) received ADT. During a median follow-up of 52 months, 15,950 men had at least 1 TE, including 8829 (55%) who had ADT and 7121 (45%) with no ADT. ADT was associated with increased risk of a TE (adjusted hazard ratio = 1.56; 95% confidence interval, 1.50-1.61; P < .0001), and duration of ADT was associated with the total number of events (P < .0001).

CONCLUSIONS:

In this population-based cohort, ADT was associated with increased risk of a TE, and longer durations of ADT were associated with more TEs. Men with intermediate- and low-risk prostate cancer should be assessed for TE risk factors before starting ADT and counseled regarding the risks and benefits of this therapy. Cancer 2011. © 2011 American Cancer Society.

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