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Cardiovascular risk and sub-clinical atherosclerosis in prostate cancer: patient with and without androgen ablation.

4605 Background: Low testosterone levels have been associated with increased cardiovascular disease risk in some reports while androgen ablation is increasingly being used in early stage prostate cancer (PCA). To address this potential co-morbidity of androgen ablation, cardiovascular risk factors and sub-clinical atherosclerosis were assessed in PCA patients with and without androgen ablation.


METHODS
Using a cross-sectional study design, 52 men with PCA with a PSA < 2.5 and no symptoms, aged 50-80 years, were studied between ≥ 6 months and < 5 years after diagnosis in two groups. The control group had no prior androgen ablative therapy. The androgen ablation group either had prior orchiectomy or were receiving androgen ablative therapy continuously ≥ for 6 months. The study endpoint was composite measure of cardiovascular disease risk comparing ablation and control PCA groups. Evaluations included: testosterone level, lipid profile, urine microalbumin, oral glucose tolerance testing, ankle-brachial index (ABI) for peripheral arterial disease estimate and coronary calcium score by electron beam computed tomography for coronary heart disease estimate.


RESULTS
Subclinical diabetes and/or impaired glucose tolerance (IGT) by two hour post tolerance glucose was substantial in both PCA groups (52% in androgen ablation and 45% in controls). Testosterone levels were low to normal (430 ± 142 mg/dl, mean ± SD) in controls (n=31) and very low (19 ± 13 mg/dl) in androgen ablated (n=21) patients. Body weight, total body fat (kg) and body mass index were higher and hemoglobin was lower in the ablation group (all p<0.05). The coronary calcium score (control 240 ± 76, mean SEM versus ablation 162 ± 45) and percent abnormal ABI (control 16% abnormal versus ablation 10% abnormal) were similar in the two groups.


CONCLUSIONS
Androgen ablation in PCA patients is not associated with measures of increased cardiovascular disease risk. These results add weight to predictions of cardiovascular safety for androgen ablation used for early stage PCA management. The high incidence of subclinical diabetes and IGT in men with PCA warrants further attention. No significant financial relationships to disclose.