Document Detail


Identification of comorbidities that place men at highest risk of death from androgen deprivation therapy before brachytherapy for prostate cancer.
MedLine Citation:
PMID:  23651926     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
PURPOSE: To determine which specific comorbidities predispose men to excess mortality by androgen deprivation therapy (ADT) given before and during brachytherapy for prostate cancer. METHODS AND MATERIALS: We analyzed 5972 men with T1c-T3b prostate cancer treated with brachytherapy-based radiation with or without neoadjuvant ADT. Cox multivariable analysis with propensity scoring was used to determine if ADT was associated with increased all-cause mortality (ACM) in men divided into groups stratified by cardiac comorbidities. Tests for interaction between risk group and outcome were performed. RESULTS: ADT was associated with increased ACM in men with a history of myocardial infarction or congestive heart failure, regardless of whether they underwent revascularization (adjusted hazard ratio [AHR], 2.1 [95% confidence interval {CI}, 1.02-4.17; p=0.04]) or not (AHR, 1.8 [95% CI, 1.05-3.20; p = 0.03]), but this effect was not seen in men with less severe comorbidity. However, among men with diabetes, there was a significant interaction with risk group (p=0.01) such that ADT was associated with excess mortality in men with low-risk disease (AHR = 2.21 [1.04-4.68]; p=0.04) but not in men with intermediate or high-risk disease (AHR, 0.64 [0.33-1.22]; p=0.17). CONCLUSIONS: ADT was associated with excess ACM in all patients with a history of congestive heart failure or myocardial infarction, regardless of whether they were revascularized, and in diabetics with low-risk disease. ADT for gland downsizing before brachytherapy should be avoided in these men.
Authors:
Arti Parekh; Ming-Hui Chen; Anthony V D'Amico; Daniel E Dosoretz; Rudi Ross; Sharon Salenius; Powell L Graham; Joshua A Beckman; Clair J Beard; Toni K Choueiri; Ronald D Ennis; Karen E Hoffman; Jim C Hu; Jing Ma; Neil E Martin; Paul L Nguyen
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-5-4
Journal Detail:
Title:  Brachytherapy     Volume:  -     ISSN:  1873-1449     ISO Abbreviation:  Brachytherapy     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-5-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101137600     Medline TA:  Brachytherapy     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2013 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Radiation Oncology, Dana Farber/Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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