A large proportion of patients with prostate cancer undergoing androgen deprivation therapy continue to die from non-cancer causes in the PSA era

Summary 

Objective

This study was conducted to determine the cause of death in patients receiving ADT for PCa in the PSA era.

Patients and methods

We followed 618 patients (mean age 73 years) with PCa initiating ADT from October 1999 to October 2007. Patients were recruited from urology clinics. Patients were regularly reviewed in a dedicated PCa clinic. Cause of death was recorded prospectively, after review of medical case notes and biochemical parameters.

Results

At median follow-up of 6.7 years, there were 377 deaths (61% mortality). Of these, 176 (47%) were attributable to PCa. Non-cancer deaths (n=201) were predominantly cardiovascular (n=125) and respiratory (n=43). Overall median presenting PSA was 37ng/ml (range 0.4–5599), significantly higher (P<0.001) in those dying from PCa (115ng/ml) than from other causes (18ng/ml). PCa specific mortality increased with PSA at presentation (14% for PSA<50ng/ml, 45% for 50–100ng/ml and 69% for >100ng/ml). When stratified for presenting age, PCa deaths were 70% (46/66) for men 60–69 years, 47% (85/180) for 70–79 years and 34% (45/131) for >80 years.

Conclusions

Many patients with PCa initiating ADT continue to die from non-cancer causes in an era of widespread PSA testing, the proportion increasing with older age at presentation. This may justify deferring hormonal treatment in suitable older asymptomatic men, sparing the burden of long-term ADT. Patients with PCa who require hormonal therapy should be assessed for cardiovascular and respiratory risk factors at the time of presentation.

Abbreviations: ADT, androgen deprivation therapy, LHRH, luteinizing hormone-releasing hormone, MRC, Medical Research Council, PCa, prostate cancer, PSA, prostate specific antigen, VACURG, Veterans Administration Cooperative Urological Research Group

Keywords: Androgen antagonists, Cardiovascular, Cause of death, Prostate cancer