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Prostate cancer: Prolonged ADT reduces cardiorespiratory fitness, raises CV morality risk

Key clinical point: Prolonged androgen deprivation therapy (ADT) exposure is associated with reduced cardiorespiratory fitness (CRF) and increased risk of cardiovascular (CV) death in patients with prostate cancer and high baseline CV risk.

Major finding: Prolonged ADT (more than 6 months) was associated with reduced CRF (adjusted odds ratio [aOR], 2.71; P = .007) and increased CV mortality (adjusted hazard ratio, 3.87; P = .028). The association between short-term ADT exposure (6 months or less) and reduced CRF was of borderline significance (aOR, 1.71; P = .052).

Study details: A retrospective cohort study of 616 patients referred for exercise treadmill testing (ETT) after a prostate cancer diagnosis (ADT group, n = 150; no ADT group, n = 466). The median time from prostate cancer diagnosis to ETT was 4.8 years.

Disclosures: The study was supported by the Goodman Master Clinician Award from Brigham and Women’s Hospital and the Gelb Master Clinician Award and the Catherine Fitch Fund from Brigham and Women’s Hospital. The corresponding author reported receiving research support from Amgen, Inc.


Some previous studies have suggested there may be an association between increased cardiovascular (CV) mortality and use of androgen deprivation therapy (ADT) in men with prostate cancer; however, not all studies have confirmed this finding. Gong et al conducted a retrospective study to further examine this potential association. Patients who underwent exercise treadmill testing (ETT) and prostate cancer were identified, and patients who began ADT prior to ETT were compared with those with prostate cancer who underwent ETT but no ADT. Prolonged (> 6 months) ADT was associated with increased CV morality and decreased cardiovascular fitness (CRF) compared with those not receiving ADT. Those receiving < 6 months ADT had decreased CRF of borderline statistical significance. While this was a select group, efforts were made to account for confounders. The results suggest close attention should be paid to cardiovascular health in patients undergoing ADT.”

Mark Klein, MD


Gong J et al. J Am Coll Cardiol CardioOnc. 2020;2(4):553-563. doi: 10.1016/j.jaccao.2020.08.011.