Background

In observational studies, men with prostate cancer treated with gonadotropin-releasing hormone (GnRH) agonists had a higher risk of cardiovascular disease (CVD) compared to men who had undergone orchiectomy. However, selection bias may have influenced the difference in risk.

Objective

To investigate the association of type of androgen deprivation therapy (ADT) with risk of CVD while minimising selection bias.

Design, setting, and participants

Semi-ecologic study of 6556 men who received GnRH agonists and 3330 men who underwent orchiectomy as primary treatment during 1992–1999 in the Prostate Cancer Database Sweden 3.0.

Outcome measurements and statistical analysis

We measured the proportion of men who received GnRH agonists as primary treatment in 580 experimental units defined by healthcare provider, diagnostic time period, and age at diagnosis. Incident or fatal CVD events in units with high and units with low use of GnRH agonists were compared. Net and crude probabilities were also analysed.

Results and limitations

The risk of CVD was similar between units with the highest and units with the lowest proportion of GnRH agonist use (relative risk 1.01, 95% confidence interval [CI] 0.93–1.11). Accordingly, there was no difference in the net probability of CVD after GnRH agonist compared to orchiectomy (hazard ratio 1.02, 95% CI 0.96–1.09). The 10-yr crude probability of CVD was 0.56 (95% CI 0.55–0.57) for men on GnRH agonists and 0.52 (95% CI 0.50–0.54) for men treated with orchiectomy. The main limitation was the nonrandom allocation to treatment, with younger men with lower comorbidity and less advanced cancer more likely to receive GnRH agonists.

Conclusion

Our data do not support previous observations that GnRH agonists increase the risk of CVD in comparison to orchiectomy.

Patient summary

We found a similar risk of cardiovascular disease between medical and surgical treatment as androgen deprivation therapy for prostate cancer.

中文翻译：

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促性腺激素释放激素激动剂，睾丸切除术和心血管疾病的风险：半生态，全国性，基于人群的研究

背景

在观察性研究中，与接受睾丸切除术的男性相比，接受促性腺激素释放激素（GnRH）激动剂治疗的前列腺癌男性患心血管疾病（CVD）的风险更高。但是，选择偏见可能已影响风险差异。

客观的

调查类型的雄激素剥夺疗法（ADT）与CVD的风险，同时最大程度地减少选择偏见。

设计，设置和参与者

在1992-1999年瑞典前列腺癌数据库3.0中，对6556名接受GnRH激动剂和3330例接受睾丸切除术作为主要治疗方法的男性进行了半生态学研究。

成果测量和统计分析

我们在由医疗服务提供者，诊断时间和诊断年龄定义的580个实验单位中测量了接受GnRH激动剂作为主要治疗药物的男性比例。比较了使用高剂量和低剂量GnRH激动剂的单位发生的事件或致命的CVD事件。还分析了净概率和粗概率。

结果与局限性

使用GnRH激动剂比例最高的单位与使用最低单位的单位之间的CVD风险相似（相对风险1.01，95％置信区间[CI] 0.93-1.11）。因此，与睾丸切除术相比，GnRH激动剂术后CVD的净发生率无差异（危险比1.02，95％CI 0.96-1.09）。接受GnRH激动剂的男性10年CVD的几率是0.56（95％CI 0.55-0.57），而接受睾丸切除术的男性则为0.52（95％CI 0.50-0.54）。主要限制是治疗的非随机分配，合并症和癌症晚期的年轻男性更有可能接受GnRH激动剂。

结论

我们的数据不支持以前的观察，即与睾丸切除术相比，GnRH激动剂会增加CVD的风险。

病人总结

我们发现，在医学和外科治疗之间，心血管疾病的风险与前列腺癌的雄激素剥夺治疗相似。