Risk Of Thromboembolic Diseases In Men With Prostate Cancer: Results From The Population-based PCBaSe Sweden

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 02 Aug 2010 - 7:00 PST

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UroToday.com - Endocrine treatment (ET), which interrupts testosterone regulation of the prostate tumor, is the cornerstone treatment for men with locally advanced or metastatic prostate cancer. A number of metabolic side-effects have been reported including increased body weight, insulin resistance, dyslipidemia, and hyperglycemia. One of the more recently investigated side-effects of ET is the increased risk of heart disease which is believed to be due to a reduced cardio-protective effect of testosterone. The current studies focused on cardiovascular and thromboembolic side-effects following endocrine treatment in the Swedish PCBaSe, which started in 1996 and captures more than 96% of all newly diagnosed, biopsy-confirmed prostate cancers.

We analyzed the relation between different types of prostate cancer treatment and the following subtypes of cardiovascular disease in 76,600 prostate cancer patients (40% ET, 35% curative treatment, and 25% surveillance): ischemic heart disease, acute myocardial infarction, arrhythmia, heart failure, and stroke, as well as the following subtypes of thromboembolic disease: deep-venous thrombosis, pulmonary embolism, and arterial embolism.

In the study on cardiovascular diseases, we found that the standardized incidence rates (SIRs) were elevated for each disease studied in all prostate cancer patients, with the highest SIR for those treated with ET, independent of circulatory disease history (SIR for myocardial infarction in men without circulatory disease history: 1.40 (95%CI: 1.31-1.49), 1.15 (1.01-1.31), and 1.20 (1.11-1.30) for men on ET, curative treatment, and surveillance, respectively).

In the study on thromboembolic diseases, we found that the SIRs for men on ET were increased for all thromboembolic diseases studies, especially deep-venous thrombosis and pulmonary embolism (2.48 (95%CI: 2.25-2.73) and 2.00 (1.81-2.22)). We also observed increased SIRs for curatively treated men and men on surveillance (eg. SIR for deep-venous thrombosis in curatively treated men 1.73 (1.47-2.01) and men on surveillance 1.27 (1.08-1.47)). Increased thromboembolic risks were maintained when stratified by different age and tumor stages strata.

The absolute risk differences indicate that less than 10 extra cases of cardiovascular or thromboembolic disease per 1,000 person-years would occur after ET.

Based on the small absolute risk differences, the high absolute risk of dying from prostate cancer when treated with ET, and the fact that ET is currently the only effective treatment for metastatic disease, these findings indicate that cardiovascular and thromboembolic risk should be considered when prescribing ET, but not constitute a contraindication when the expected gain is tangible.

Related reading:

Van Hemelrijck M, Garmo H, Holmberg L, Ingelsson E, Bratt O, Bill-Axelson A, et al. Absolute and Relative Risk of Cardiovascular Disease in Men With Prostate Cancer: Results From the Population-Based PCBaSe Sweden. J Clin Oncol. 2010 Published online June 21.

Written by Mieke Van Hemelrijck, MSc as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations, etc., of their research by referencing the published abstract.

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