Long term androgen deprivation therapy in prostate cancer

Oral oestrogens were the first line treatment for prostate cancer until they were found to be associated with cardiovascular toxicity in 30% of men.1 Oestrogens were superseded by gonadotrophin releasing hormone agonists, which—on the basis of short term studies—were thought to have negligible cardiovascular toxicity.2 3 Gonadotrophin releasing hormone agonists are currently used to delay the progression of advanced disease. Recently, their role has been extended to include adjuvant or neoadjuvant treatment for men having radical radiotherapy and for those with rising concentrations of prostate specific antigen after radical surgery with curative intent (presumed small volume residual disease), even though survival benefits remain unproven.2 Thus, patients are increasingly exposed to long term androgen deprivation therapy, and may take gonadotrophin releasing hormone agonists for more than 10 years. In these circumstances, the cardiovascular toxicity associated with this treatment is being re-evaluated.

A recent systematic review summarised the adverse effects of long term androgen deprivation therapy in men with prostate cancer; it found that this treatment was associated with an increased risk of atherosclerosis and cardiovascular disease.4 The findings are not surprising because low concentrations of circulating testosterone have …