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From the Winter 2017 Quest

Alarge prospective study found that men without preexisting cardiovascular disease had a significantly higher risk of heart failure after having androgen deprivation therapy (ADT) to treat localized prostate cancer.

The study included 7,637 men with prostate cancer, 30% of whom had ADT. All the men initially underwent active surveillance.

ADT was associated with an 81% increased risk of heart failure in men who did not have preexisting cardiovascular disease. For men with preexisting cardiovascular disease, ADT was associated with 44% elevated risk of arrhythmia and a three-fold higher risk of developing a conduction disorder.

As with prospective studies, the data shows a correlation, not a cause-and-effect relationship. “This study provides the basis for identifying high-risk men treated with ADT who might benefit from regular cardiac monitoring and lifestyle modification recommendations,” the study authors wrote.

Br J Cancer. 2017 Oct 10;117(8):1233-1240. doi: 10.1038/bjc.2017.280. Epub 2017 Aug 24.

Androgen-deprivation therapy (ADT) is also called hormonal therapy. It can be used in men who have prostate cancer that has spread too far to be cured by surgery or radiation, or if cancer comes back.

Large Analysis Finds No Link Between Alzheimer’s or Dementia Risks and ADT



An analysis of more than 1.2 million men with prostate cancer found no increased risk for Alzheimer’s disease in men treated with androgen-deprivation therapy (ADT).

The men in the study were Medicare patients aged 67 years or older who had advanced prostate cancer. Investigators examined 14 years of claims data. Of the 1.2 million men in the study, 35% were treated with ADT (chemical or surgical). Almost 9% of the men developed Alzheimer’s and 18.8% developed dementia. Another 26-33% of the men died without having Alzheimer’s or dementia.

In adjusted risk model analyses, there was actually a 2% decrease in the rate of Alzheimer’s in men who had ADT, possibly attributed to the high death rate in the study subjects. There was also a 1% decreased risk of dementia, which the authors said was not clinically important.

Other studies have found conflicting results regarding an increased risk of dementia, Alzheimer’s and other cognitive impairments in patients who undergo ADT, including a metaanalysis by Nead et al. in 2017 that showed the risk for dementia was 47% higher after ADT when compared to a lesser-exposed group of men. The authors of the new study suggested that the different findings could come from using different methods and source data. Future research will continue to search for clarity on the possible link so clinicians can advise patients about the potential risks of ADT.

J Clin Oncol. 2017 Oct 20;35(30):3401-3409. doi: 10.1200/JCO.2017.72.6109. Epub 2017 Aug 25.

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