Risks of Anti-Androgen Therapy

Anti-androgen therapy, administered in the treatment of prostate cancer, implies the use of agonists of gonadotropin-releasing hormone (GnRH), like leuprolide and goserelin, beside oral anti-androgens, like flutamide and bicalutamide. Some recent trials have suggested the hypothesis that these drugs provoke an increase in cardiovascular risk and diabetes risk. With an observational trial, 37,000 patients treated for prostate cancer and belonging to the Veterans Administration, have been examined. About 40% of them have been treated with anti-androgens, and, after analyses adjusted for potential confounders, it was seen that monotherapy with GnRH agonists is associated with a statistically significant increased risk for the onset of type 2 diabetes (Hazard Ratio 1.28), myocardial infarction (HR 1.28) and stroke (1.21).

  1. Keating NL et al. Diabetes and cardiovascular disease during androgen deprivation therapy: Observational study of veterans with prostate cancer. Journal of National Cancer Institute 2010 Jan 6; 102:39
  2. Albertsen PC. Does the benefit justify the risk? Journal of National Cancer Institute 2010 Jan 6; 102:4
(Oncology)

Our comment:

The problem is real and it becomes as much important as the use of these kinds of therapies increases. Once, they were used only for advanced and symptomatic prostate cancers, while nowadays we tend to use them also in asymptomatic patients with a recurrent PSA increase after chemotherapy or radiotherapy. Since in these patients the benefit from these therapies is not at all clear, it is better to consider the potential consequent damage.
August 2010
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