Older Age, Prolonged ADT Tied to Increased Risk of Diabetes and Cardiovascular Disease

SAN FRANCISCO—Although there was no observed increased risk in men with non-metastatic prostate cancer, age and length of androgen deprivation therapy (ADT) administration demonstrated a trend, indicating that further understanding of the mechanisms for this connection is needed. 

3 - Alicia K. Morgans, MDADT has been associated with an increased risk for developing diabetes and cardiovascular disease (CVD), but, as Alicia Katherine Morgans, MD, assistant professor of medicine at Vanderbilt-Ingram Cancer Center, Nashville, Tennessee, and colleagues point out, “this is controversial, particularly for CVD.”

The investigators prospectively assessed the relationship between ADT and incident diabetes and CVD in the Prostate Cancer Outcomes Study (PCOS)—a population-based cohort of prostate cancer survivors who were followed longitudinally for 15 years from diagnosis.

Patients were divided into groups receiving short-term ADT (less than 2 years), prolonged ADT (2 years or more), and no ADT to assess the impact of exposure length on subsequent diagnoses (determined by patient report and cause of death data). Investigators also evaluated the effects of age at diagnosis, race, stage, and comorbidity on the development of diabetes and CVD.

Among 3,526 men with comorbidity and treatment data, 2,985 men without baseline diabetes and 3,112 men without baseline CVD constituted the diabetes and CVD cohorts, respectively.

Compared to no ADT exposure, prolonged ADT was associated with an increased risk of diabetes and CVD, and this risk increased steadily over age 76 (TABLE).

Odds Ratios by Age at Diagnosis

Age 74

Age 80

Diabetes

2.11 (95% CI 1.02–4.36)

2.65 (95% CI 1.09–6.47)

CVD

1.89 (95% CI 1.02-3.49)

3.19 (95% 1.25–8.17)

Importantly, men younger than 70 at prostate cancer diagnosis did not experience any increased risk of diabetes or CVD, regardless of duration of ADT exposure.

The number of comorbidities also modified the risk of diabetes and CVD: patients with three or more comorbidities were more than four times more likely to develop diabetes (OR = 4.25, 95% CI 2.3-7.9) and more than eight times more likely to develop CVD (OR = 8.1, 95% CI 4.3-5.5), compared to patients with no comorbidities.

“The relationship between ADT and development of CVD and diabetes may be dependent upon age at diagnosis in addition to length of ADT administration—with longer ADT exposure predominantly increasing risk among older men only,” Dr. Morgans and colleagues concluded. “Closer monitoring for development of diabetes and CVD may be most important among older men receiving prolonged ADT, especially those with other comorbidities.” 

Source: Morgans AK, Fen KH, Koyama T, et al. Influence of age on incident diabetes (DM) and cardiovascular disease (CVD) among prostate cancer survivors receiving androgen deprivation therapy (ADT). Abstract presented at 2014 Genitourinary Cancers Symposium; San Francisco, California. January 30, 2014.