Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer
Open accessAbstract
Purpose: Androgen deprivation therapy with a gonadotropin-releasing hormone (GnRH) agonist is associated with increased fat mass and insulin resistance in men with prostate cancer, but the risk of obesity-related disease during treatment has not been well studied. We assessed whether androgen deprivation therapy is associated with an increased incidence of diabetes and cardiovascular disease. Patients and Methods: Observational study of a population-based cohort of 73,196 fee-for-service Medicare enrollees age 66 years or older who were diagnosed with locoregional prostate cancer during 1992 to 1999 and observed through 2001. We used Cox proportional hazards models to assess whether treatment with GnRH agonists or orchiectomy was associated with diabetes, coronary heart disease, myocardial infarction, and sudden cardiac death. Results: More than one third of men received a GnRH agonist during follow-up. GnRH agonist use was associated with increased risk of incident diabetes (adjusted hazard ratio [HR], 1.44; P < .001), coronary heart disease (adjusted HR, 1.16; P < .001), myocardial infarction (adjusted HR, 1.11; P = .03), and sudden cardiac death (adjusted HR, 1.16; P = .004). Men treated with orchiectomy were more likely to develop diabetes (adjusted HR, 1.34; P < .001) but not coronary heart disease, myocardial infarction, or sudden cardiac death (all P > .20). Conclusion: GnRH agonist treatment for men with locoregional prostate cancer may be associated with an increased risk of incident diabetes and cardiovascular disease. The benefits of GnRH agonist treatment should be weighed against these potential risks. Additional research is needed to identify populations of men at highest risk of treatment-related complications and to develop strategies to prevent treatment-related diabetes and cardiovascular disease.
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Hormonal therapy side effects include hot flashes, osteoporosis, anemia, fatigue, sarcopenia, gynecomastia, loss of libido, erectile dysfunction, diabetes risk, cardiovascular disease risk, fatal cardiac events, and possible emotional distress.
“These side effects include: hot flashes, osteoporosis, anemia, fatigue, sarcopenia, gynecomastia, loss of libido, erectile dysfunction, risk of diabetes, risk of cardiovascular disease and fatal cardiac events as well as possible emotional distress [9–13].”
From Prostate cancer: Psychosocial implications and management (2008) · cites this paper as [12]
The Discussion (page unavailable) reports that GnRH agonist therapy was associated with increased risks of diabetes, cardiovascular disease, and sudden cardiac death in older men with local or regional prostate cancer. The paper does not substantiate the other listed side effects, such as hot flashes, anemia, sexual dysfunction, or emotional distress; its findings also concern GnRH agonists rather than hormonal therapy generally. (LLM, conf=0.88)
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- Authors
- Keating, N. L., O'Malley, A. J., & Smith, M. R.
- Affiliations
- Brigham and Women's Hospital (US)
- From the Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital; the Department of Health Care Policy, Harvard Medical School; and the Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
- Venue
- Journal of Clinical Oncology
- Published
- 2006-09-20
- Volume
- 24
- Issue
- 27
- Pages
- 4448-4456
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2098998490
- Semantic Scholar
- 40720a1c1bfca25b842bea69c04aaeadb79f4932
- Cited by
- 1,455
- References
- 41
- Citations by year
- 2026: 26 · 2025: 35 · 2024: 41 · 2023: 43 · 2022: 57 · 2021: 53 · 2020: 67 · 2019: 52 · 2018: 71 · 2017: 73 · 2016: 83 · 2015: 73 · 2014: 96 · 2013: 88 · 2012: 119
- FWCI
- 57.96
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (P50 CA 90381, P50CA090381)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Treatment and Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Prostate Cancer Diagnosis and Treatment
- Keywords
- androgen deprivation therapy, prostate cancer, GnRH agonist, orchiectomy, diabetes mellitus, cardiovascular disease, coronary artery disease, myocardial infarction, sudden cardiac death, treatment side effects, older men
- MeSH terms
- Aged, Aged, 80 and over, Androgen Antagonists, Coronary Disease, Diabetes Mellitus, Heart Diseases, Humans, Insulin Resistance, Gonadotropin-Releasing Hormone, Male, Myocardial Infarction, Orchiectomy, Prostatic Neoplasms, Cohort Studies, Proportional Hazards Models, Odds Ratio, Death, Sudden, Cardiac, SEER Program, Antineoplastic Agents, Hormonal
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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