This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Men's Health  • Prostate Disease  • Oncology  • Prostate Cancer  • Cardiovascular System  • Cardiovascular Disease/ Myocardial Infarction  • Drug Therapy  • Adverse Effects  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

Akash Nanda, MD, PhD; Ming-Hui Chen, PhD; Michelle H. Braccioforte, BS; Brian J. Moran, MD; Anthony V. D’Amico, MD, PhD

JAMA. 2009;302(8):866-873.

Context  Hormonal therapy (HT) when added to radiation therapy (RT) for treating unfavorable-risk prostate cancer leads to an increase in survival except possibly in men with moderate to severe comorbidity. However, it is unknown which comorbid conditions eliminate this survival benefit.

Objective  To assess whether neoadjuvant HT use affects the risk of all-cause mortality in men with prostate cancer and coronary artery disease (CAD)–induced congestive heart failure (CHF) or myocardial infarction (MI), CAD risk factors, or no comorbidity.

Design, Setting, and Patients  A total of 5077 men (median age, 69.5 years) with localized or locally advanced prostate cancer were consecutively treated with or without a median of 4 months of neoadjuvant HT followed by RT at a suburban cancer center between 1997 and 2006 and were followed up until July 1, 2008. Cox regression multivariable analyses were performed assessing whether neoadjuvant HT use affected the risk of all-cause mortality, adjusting for age, year and type of RT, treatment propensity score, and known prostate cancer prognostic factors in each comorbidity group.

Main Outcome Measure  Risk of all-cause mortality.

Results  Neoadjuvant HT use was not associated with an increased risk of all-cause mortality in men with no comorbidity (9.6% vs 6.7%, adjusted hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.72-1.32; P = .86) or a single CAD risk factor (10.7% vs 7.0%, adjusted HR, 1.04; 95% CI, 0.75-1.43; P = .82) after median follow-ups of 5.0 and 4.4 years, respectively. However, for men with CAD-induced CHF or MI, after a median follow-up of 5.1 years, neoadjuvant HT use was significantly associated with an increased risk of all-cause mortality (26.3% vs 11.2%, adjusted HR, 1.96; 95% CI, 1.04-3.71; P = .04).

Conclusion  Neoadjuvant HT use is significantly associated with an increased risk of all-cause mortality among men with a history of CAD-induced CHF or MI but not among men with no comorbidity or a single CAD risk factor.

Author Affiliations: Harvard Radiation Oncology Program (Dr Nanda) and Department of Radiation Oncology (Dr D’Amico), Brigham & Women's Hospital–Dana-Farber Cancer Institute, Boston, Massachusetts; Department of Statistics, University of Connecticut, Storrs (Dr Chen); and Prostate Cancer Foundation of Chicago, Westmont, Illinois (Ms Braccioforte and Dr Moran).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Does Hormonal Therapy for Prostate Cancer Raise Mortality Risk?
JWatch Oncology and Hematology 2009;2009:4-4.
FULL TEXT  

All you need to read in the other general journals
BMJ 2009;339:b3511-b3511.
FULL TEXT