Androgen deprivation therapy (ADT) plus radiation therapy (RT) for unfavorable-risk prostate cancer is not associated with an increased risk for cardiovascular mortality compared with RT alone, according to investigators.

The finding is from a secondary analysis of prospectively obtained data from 1463 men with unfavorable-risk clinically localized prostate cancer (PCa) who participated in the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized controlled trial. The analysis revealed no significant difference in 5-year cardiovascular mortality rates between ADT plus RT and RT alone overall (2.3% vs 3.3%, respectively) or in subgroups of men with a history of 1 or more preexisting comorbidities (3.2% vs 5.3%), a history of 2 or more preexisting comorbidities (6.9% vs 8.3%), or preexisting cardiovascular disease (3.6% vs 4.3%), a team led by Vinayak Muralidhar, MD, MSc, of Brigham and Women’s Hospital in Boston, Massachusetts, reported in Cancer.

“These findings suggest that ADT may be a safe management option for men who have unfavorable-risk prostate cancer regardless of comorbidity status,” Dr Muralidhar and colleagues concluded. “However, the possible side effects of ADT and the high risk of other-cause mortality still should be weighed against the possible cancer-specific mortality benefit when making individuals patient-level treatment decisions.”

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The investigators defined unfavorable-risk PCa according to National Comprehensive Cancer Network criteria (clinical T2b-T4, Gleason score 7-10, or PSA level greater than 10 ng/mL). They defined cardiovascular mortality as death from cardiac causes, stroke, or other vascular causes.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Butler SS, Mahal BA, Moslehi JJ, et al. Risk of cardiovascular mortality with androgen deprivation therapy in prostate cancer: A secondary analysis of the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial. Cancer. Published online April 27, 2021. doi:10.1002/cncr.33486