Cardiovascular outcomes after curative prostate cancer treatment: A population-based cohort study

Camilla Kjellstadli; Rachel B Forster; Tor Å Myklebust; Tone Bjørge; Kaare H Bønaa; Svein I Helle; Rune Kvåle

doi:10.3389/fonc.2023.1121872

Cardiovascular outcomes after curative prostate cancer treatment: A population-based cohort study

Front Oncol. 2023 Mar 31:13:1121872. doi: 10.3389/fonc.2023.1121872. eCollection 2023.

Authors

Camilla Kjellstadli^{1

2}, Rachel B Forster¹, Tor Å Myklebust^{3

4}, Tone Bjørge^{5

6}, Kaare H Bønaa^{7

8}, Svein I Helle², Rune Kvåle^{1

2}

Affiliations

¹ Department of Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway.
² Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway.
³ Department of Registration, Cancer Registry of Norway, Oslo, Norway.
⁴ Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
⁵ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
⁶ Section for Cervical Cancer Screening, Cancer Registry of Norway, Oslo, Norway.
⁷ Department of Cardiology, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
⁸ Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract

Objective: To investigate differences in cardiovascular disease (CVD) morbidity and mortality after radical prostatectomy or definitive radiotherapy with or without androgen deprivation therapy (ADT).

Materials and methods: We used population-based data from the Cancer Registry of Norway, the Norwegian Patient Registry and the Norwegian Cause of Death Registry including 19 289 men ≤80 years diagnosed with non-metastatic prostate cancer during 2010-2019. Patients were treated with radical prostatectomy or definitive radiotherapy. We used competing risk models to compare morbidity from overall CVD, acute myocardial infarction (AMI), cerebral infarction, thromboembolism, and CVD-specific mortality for the overall cohort and stratified by prognostic risk groups.

Results: After a median follow-up time of 5.4 years (IQR 4.6 years), there were no differences in adjusted rates of AMI, cerebral infarction, and CVD-specific death between radical prostatectomy and definitive radiotherapy in any of the prognostic risk groups. Rates of overall CVD (0.82; 95% CI 0.76-0.89) and thromboembolism (0.30; 95% CI 0.20-0.44) were lower for definitive radiotherapy than radical prostatectomy during the first year of follow-up. After this overall CVD rates (1.19; 95% CI 1.11-1.28) were consistently higher across all risk groups in patients treated with definitive radiotherapy, but there were no differences regarding thromboembolism.

Conclusions: During the first years after treatment, no differences were found in rates of AMI, cerebral infarction, and CVD-specific death between radiotherapy and radical prostatectomy in any of the prognostic risk groups. This suggests that ADT use in combination with radiotherapy may not increase the risks of these outcomes in a curative setting. The increased overall CVD rate for definitive radiotherapy after the first year indicates a possible relationship between definitive radiotherapy and other CVDs than AMI and cerebral infarction.

Keywords: cardiovascular disease; curative treatment; definitive radiotherapy; epidemiology; prostate cancer; radical prostatectomy; registry.

Grants and funding

This study was supported by the Norwegian Cancer Society (208154-2019) and the Norwegian Institute of Public Health. The funding agency provided funding but had no role in the research conducted.