Association of Androgen Deprivation Therapy with Metabolic Disease in Prostate Cancer Patients: An Updated Meta-Analysis

Justin Swaby; Ankita Aggarwal; Akshee Batra; Anubhav Jain; Lakshya Seth; Nickolas Stabellini; Marcio Sommer Bittencourt; Darryl Leong; Zachary Klaassen; Pedro Barata; Nicolas Sayegh; Neeraj Agarwal; Martha Terris; Avirup Guha

doi:10.1016/j.clgc.2022.12.006

Association of Androgen Deprivation Therapy with Metabolic Disease in Prostate Cancer Patients: An Updated Meta-Analysis

Clin Genitourin Cancer. 2023 Jun;21(3):e182-e189. doi: 10.1016/j.clgc.2022.12.006. Epub 2022 Dec 26.

Authors

Affiliations

¹ Department of Cardiovascular Disease, Augusta University, Augusta, GA.
² Department of Cardiology, Ascension Providence Hospital, MI.
³ Department of Internal Medicine, University of Vermont, Burlington, VT.
⁴ Department of Cardiology, Ascension Genesys Hospital, Garden city, MI.
⁵ Department of Hematology- Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH.
⁶ Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA.
⁷ Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
⁸ Division of Surgery: Urology, Augusta University, Augusta, GA.
⁹ Genitourinary Medical Oncology, Tulane University Medical School, New Orleans, LA.
¹⁰ Huntsman Cancer Institute, University of Utah, UT.
¹¹ Department of Cardiovascular Disease, Augusta University, Augusta, GA. Electronic address: aguha@augusta.edu.

PMID: 36621463
DOI: 10.1016/j.clgc.2022.12.006

Abstract

Background: Androgen deprivation therapy (ADT), a backbone treatment for advanced prostate cancer (PC), is known to have a variety of metabolic side effects. We conducted an updated meta-analysis to quantify the metabolic risks of ADT.

Materials and methods: We searched PubMed, Web of Science, and Scopus in May of 2022 for studies investigating the risk of metabolic syndrome (MetS), diabetes, and hypertension from ADT in PC patients using keywords. Only full-length studies with a control group of PC patients not on ADT were included. All results compatible with each outcome domain in each included study were sought. For included studies, relative risk (RR) was pooled using a random effects model and a trim-fill approach was used to adjust for publication bias.

Results: 1,846 records were screened, of which 19 were found suitable for data extraction. Five studies, including 891 patients, were evaluated for MetS as an outcome, with the random effects model showing a pooled RR of 1.60 ([95% Confidence Interval (CI), 1.06-2.42]; P=0.03) for patients on ADT while twelve studies, including 336,330 patients, examined diabetes as an outcome, and the random effects model showed a RR of 1.43 ([95% CI, 1.28-1.59]; P< 0.01). After adjustment for publication bias, ADT was associated with a 25% increased risk for diabetes but was not associated with MetS. 4 studies, including 7,051 patients, examined hypertension as an outcome, and the random effects model showed a RR of 1.30 ([95% CI, 1.08-1.55]; P=0.18) in ADT patients.

Conclusion: In patients with PC, ADT was not associated with MetS and the association with diabetes was not as strong as previously reported. Our novel meta-analysis of hypertension showed that ADT increased the risk of hypertension by 30%. These results should be understood in the context of collaborating care between a patient's oncologist and primary care provider to optimize care.

Keywords: Cardio-oncology; Cardiovascular risk; Diabetes; Hypertension; Metabolic syndrome.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Androgen Antagonists / adverse effects
Androgens
Diabetes Mellitus* / chemically induced
Diabetes Mellitus* / drug therapy
Diabetes Mellitus* / epidemiology
Humans
Hypertension* / chemically induced
Hypertension* / epidemiology
Male
Metabolic Diseases* / chemically induced
Metabolic Diseases* / complications
Metabolic Diseases* / epidemiology
Prostatic Neoplasms* / therapy

Substances

Androgen Antagonists
Androgens