Orchidectomy more Cardiotoxic compared to Medical Castration in Prostate Cancer patients

The role of androgen deprivation therapy (ADT) in the treatment of prostate cancer is debatable. ADT has a rapid and dramatic clinical effect in men with symptomatic metastatic prostate cancer. ADT is widely regarded as the first-line treatment for symptomatic metastatic prostate cancer.

A new study discovered an increased risk of Acute Myocardial Infarction (AMI) in patients with prostate cancer, particularly those undergoing surgical castration rather than Gonadotropin-Releasing Hormone (GnRH) therapies.

This study was conducted by Wei-Chih Kan and team with the objective to compare the risk of major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with prostate cancer who received either surgical castration or GnRH therapies. The findings of this study were published in The Journal of Urology.

From 2008 to 2017, the researchers used Taiwan Cancer Registry (TCR) and Taiwan's National Health Insurance Research Database (NHIRD) to identify 8,413 patients receiving GnRH therapies versus 694 receiving surgical castration. Following the study, the median follow-up period was three years.

The findings of this study are:

1. In patients receiving GnRH therapies or surgical castration, the crude incidences of 3-year mortality and MACCEs were 19.90% vs. 26.51% and 8.23% vs. 8.65%, respectively.

2. Despite no significant differences in MACCEs between groups after adjusting for age, cancer stage, and comorbidities, there was a slight increase in the incidence of acute myocardial infarction (AMI) in patients receiving surgical castration compared to those receiving GnRH therapies.

3. The mortality adjusted hazard ratios for MACCEs and AMI were 1.11 and 1.8-fold higher in patients receiving surgical castration, respectively, than in those receiving GnRH therapies.

4. Notably, in a subgroup analysis based on cancer stage, patients with cancer stage IV had the highest risk of AMI when receiving surgical castration versus GnRH therapies.

In conclusion, The findings raise concerns about the cardiac safety of surgical castration versus GnRH therapies.

Reference:

Kan, W.-C., Hsieh, K.-L., Chen, Y.-C., Ho, C. H., Hong, C.-S., Chiang, C.-Y., Wu, N.-C., Chen, M., Shih, J.-Y., Chen, Z.-C., & Chang, W.-T. (2021). Comparison of Surgical or Medical Castration-Related Cardiotoxicity in Patients With Prostate Cancer. In Journal of Urology. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/ju.0000000000002340