Androgen suppression
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Synonyms and keywords: Androgen ablation; androgen deprivation; androgen deprivation therapy, ADT
Overview
Androgen suppression is a medical treatment to suppress or block the production or action of male sex hormones, typically in order to attempt to treat certain types of cancer that rely upon male hormones for its growth. Androgen suppression therapy, which includes GnRH agonist, antiandrogens and bilateral orchiectomy, is used for the treatment of prostate cancer. Androgen suppression therapy use has been associated with increased incidence of cardiovascular risk factors such as obesity, decreased insulin sensitivity and dyslipidemia.
Types of Androgen Suppression Therapy
- GnRH agonist
- Antiandrogens
- bilateral orchiectomy
- Treatment with female hormones
Cardiovascular Effects of Androgen Suppression Therapy in Prostate Cancer
Androgen suppression therapy, which includes GnRH agonist, antiandrogens and bilateral orchiectomy, is used for the treatment of prostate cancer. Androgen suppression therapy use has been associated with increased incidence of cardiovascular risk factors. In fact, androgen suppression therapy therapy contributes to an increase in obesity with modification of the body composition, a decrease in insulin sensitivity and dyslipidemia. The science advisory from the American Heart Association, American Cancer Society, and American Urological Association recommends regular follow up for the evaluation of cardiovascular risk factors among patients with prostate cancer on androgen suppression therapy. Among patients with pre-existing cardiovascular disease, secondary prevention should be optimized.
In addition, androgen suppression therapy use is associated with increased risk of myocardial infarction (MI), stroke and shorter time to MI (3). A cohort of 73,196 patients with prostate cancer, among which one third received GnRH agonist revealed an association between GnRH agonist use and increased incidence of diabetes (HR, 1.44; P < 0.001), coronary heart disease (HR, 1.16; P < 0.001) and myocardial infarction (HR, 1.11; P = 0.03).
The association between androgen suppression therapy use and increased cardiovascular mortality is controversial. While this association has been reported in some studies, others suggest that this association is only valid when the subject has co-existing comorbidities or other cardiac risk factors (7). A metanalysis of 8 randomized clinical trials of 4141 patients demonstrates that androgen suppression therapy use in prostate cancer is not significantly associated with increased cardiovascular mortality (RR, 0.93; 95% CI, 0.79-1.10; P = 0.41). However, a metanalysis of 11 randomized clinical trials of 4805 patients reports that androgen suppression therapy use is associated with decreased prostate cancer related mortality (RR, 0.69; 95% CI, 0.56-0.84; P < 0.001) and decreased overall mortality (RR, 0.86; 95% CI, 0.80-0.93; P <0.001).
References
See also
This article incorporates public domain material from the U.S. National Cancer Institute document "Dictionary of Cancer Terms".