Androgen Deprivation Therapy - Yes or No?

The American Heart Association, American Cancer Society, American Urological Association, and American Society for Radiation Oncology came together early last year and issued a joint statement regarding an association between androgen deprivation therapy (ADT) and an increase risk for cardiovascular events.  This scientific advisory was based upon secondary analysis of several major observational studies.  

So in typical medical badminton fashion, a study was published in JAMA today stating the opposite, that ADT was not associated with an increase risk of cardiovascular events.  Well, who's right?  These authors claimed the upper hand because their conclusion was based upon a meta-analysis of 8 randomized controlled trials (RCT) involving 4,141 patients followed for 7-13yrs, rather than a rehash of epidemiological studies.

The two editorialists pointed out that while RCTs are the gold standard in proving cause & effect, those of us practicing in the trenches must always ask ourselves whether our patient has enough characteristics similar to the group studied for the conclusion to be applied.  Different patient populations, study design, selection bias, etc may have confounded the data still.  Remember the initial turmoil that the Women's Health Initiative stirred up 9yrs ago?  Then we began to realize that the 65yo female who's 10yrs post-menopause might have different physiology than the 45-50yo w/peri-menopausal issues.

But what are we to do in the meantime while we wait for a more definitive answer?  Let's realize that many of the same patients w/prostate cancer are also dealing w/heart disease.  Regardless of how ADT affects their cardiovascular event rate, these patients must have their heart disease risk factors aggressively treated.  And for now, the major medical groups haven't rescinded their collective guideline.

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