EURURO Vol. 72 No. 6

920 1030

Platinum Priority – Prostate Cancer
Editorial by Nancy L. Keating on pp. 929–930 of this issue
Gonadotropin-releasing Hormone Agonists, Orchiectomy, and
Risk of Cardiovascular Disease: Semi-ecologic, Nationwide,
Population-based Study
Frederik Birkebæk Thomsen [13_TD$DIFF] Fredrik Sandin Hans Garmo Ingela Franck Lissbrant
Go¨ran Ahlgren Mieke Van Hemelrijck Jan Adolfsson David Robinson Pa¨r Stattin
a Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; b Regional Cancer Centre
Uppsala O¨ rebro, Uppsala University Hospital, Uppsala, Sweden; c Cancer Epidemiology Group, School of Medicine, Division of Cancer Studies, King’s College
London, London, UK; dDepartment of Oncology, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
e Department of Urology, SUS Malmo¨, Region Ska˚ne, Malmo¨, Sweden; f Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet,
Stockholm, Sweden; g CLINTEC[15_TD$DIFF]-department, Karolinska Institutet, Stockholm, Sweden; h Department of Urology, Ryhov Hospital, Jo¨nko¨ping, Sweden;
i Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden; j Department of Surgical and Perioperative Sciences, Urology and Andrology,
Umea˚ University Hospital, Umea˚, Sweden
available at
journal homepage:
Article info
Article history:
Accepted June 24, 2017
Associate Editor:
Giacomo Novara
Keywords:
Prostate cancer
Androgen deprivation therapy
Gonadotropin-releasing
hormone
Orchiectomy
Cardiovascular risk
Prostate Cancer Database
Sweden (PCBaSe)
Abstract
Background: In observational studies, men with prostate cancer treated with gonado-
tropin-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 [16_TD$DIFF]treatment during
1992–1999 in the Prostate Cancer Database Sweden 3.0.
Outcome measurements and statistical analysis: We measured the proportion of men
who received GnRH agonists as primary [16_TD$DIFF]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 [17_TD$DIFF]were [18_TD$DIFF]compared. Net
and crude probabilities were[19_TD$DIFF] also analysed.
Results and limitations: The risk of CVD was similar between units with the highest and
units with the lowest proportion of GnRH agonist use (relative risk 1.01, 95% confidence
interval [CI] 0.93–1.11). Accordingly, there was no difference in the net probability of
CVD after GnRH agonist compared to orchiectomy[3_TD$DIFF] (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 [20_TD$DIFF]treatment as androgen deprivation therapy for prostate cancer.
* Corresponding author. Copenhagen Prostate Cancer Centre, Rigshospitalet, Ole Maaløes Vej 24, afs
7521, 2200 Copenhagen, Denmark. Tel. +45 35457125; Fax: +45 35452726.
E-mail address: (F.B. Thomsen).
0302-2838/# 2017 European Association of Urology. Published by Elsevier B.V. This is an open access article under the CC
BY-NC-ND license ).