Abstract
Background: Extended use of androgen deprivation therapy (ADT) is common among elderly men; however, the associated long-term toxic effects have not been well documented.
Methods: We conducted a population based cohort study by analyzing a total of 46,587 men diagnosed with localized prostate cancer and survived at least 5 years after diagnosis in the Surveillance, Epidemiology, and End Results (SEER) -Medicare program to estimate the risk of fracture among men who received long-term ADT.
Results: More than 46% of ADT users received more than 25 months of treatment. The hazard ratio (HR) of hospitalized fracture was 1.47 (95 percent confidence interval, 1.29 to 1.67) among men receiving 36 or more doses of Gonadotropin-releasing hormone (Gn-RH) agonist. Men treated with ADT were associated with a 57.8% increase in the risk of multiple fractures after the first 24 months of treatment. Older age, higher comorbidity, history of fracture and stoke were independently associated with increased fracture risk. Men who were 75 years of age or older and received GnRH agonist for more than 24 months were associated with a 3.63 times risk of having fracture, compared with those aged 66 to 74 and have ADT shorter than 24 months.
Conclusion: Men who are older and with comorbidity are more likely to received long-term ADT than attempted curative treatment. However, those men are also at substantial risk of fracture. The increased risk of fracture along with ADT should be carefully evaluated before initiating a treatment.
Citation Information: Cancer Prev Res 2010;3(12 Suppl):B11.