• prostate neoplasms;
  • propensity score;
  • cardiac glycoside;
  • hypoxia-inducible factor 1α;
  • mortality;
  • digoxin


  • To examine the association between digoxin exposure and mortality in men with prostate cancer using linked Irish National Cancer Registry and pharmacy claims data.

Patients and Methods

  • Prostate cancer cases were identified from the database and digoxin exposure at prostate cancer diagnosis was identified from prescription claims.
  • Digoxin users were matched to non-users using a propensity score to identify men with similar cardiovascular comorbidity.
  • Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the association between digoxin exposure and all-cause and prostate cancer-specific mortality (PCSM).
  • Analyses were repeated in the propensity score-matched cohort.
  • Effect modification of treatment with radiation or androgen-deprivation therapy by digoxin exposure was also assessed.


  • In all, 5732 men with a prostate cancer diagnosis (2001–2006) were identified (digoxin exposed, 391). The median follow-up was 4.3 years.
  • Digoxin exposure was associated with a small non-significant increase in PCSM in the full cohort (HR 1.13, 95% CI 0.91, 1.42) and the propensity. score-matched cohort (HR 1.17, 95% CI 0.88, 1.57).
  • Adjusted HRs for all-cause mortality were increased for digoxin exposed men (HR 1.24, 95% CI 1.07, 1.43).
  • Interactions with treatments received were not significant.


  • These results suggest digoxin exposure is not associated with reduced PCSM.
  • Further investigation of other cardiac glycosides that have shown anti-cancer potential may be warranted.