Introduction

Androgen deprivation therapy (ADT) plays an important role in managing prostate cancer, both as a primary treatment for metastatic disease and as a useful adjunct to radiotherapy or surgery with curative intent. However, some reports showed that ADT significantly increased cardiovascular risk. It has also been proposed that gonadotrophin-releasing hormone (GnRH) agonist may have negative effects on cardiac function at the receptor level. At present, little is known as to whether or not short-term ADT affects cardiac function. Brain-type natriuretic peptide (BNP) is in widespread use as a cardiac marker that can identify the risk of cardiovascular events. In order to assess the adverse impact of short-term ADT on cardiac function, we evaluated the change in BNP levels in patients undergoing radical prostatectomy (RP) with or without preoperative ADT.

Methods

Between 2014 and 2016, 112 Japanese patients underwent RP in our hospital. Of them, 64 patients whose BNP levels were available and who had no prior cardiovascular disease were included in this retrospective study. BNP levels were evaluated before prostate biopsy and before RP. In this cohort, 31 patients received ADT preoperatively by combined androgen blockade using GnRH agonist and bicalutamide (ADT group), and the other 33 patients underwent RP without ADT (control group). The change in BNP levels was assessed in each group.

Results

The median age and initial PSA level were 68 years and 8.8 ng/ml, respectively. No patients newly developed cardiovascular events during the study period. There were no significant differences between the two groups in age, body mass index, serum testosterone level, and comorbidities such as hypertension, diabetes, and dyslipidemia. The median BNP level before prostate biopsy was 13.9 pg/ml in the ADT group and 12.1 pg/ml in the control group (p = 0.73). The median interval between evaluations of the BNP level was 12 (range 9-26) months in the ADT group and 6 (range 1-9) months in the control group. The median duration of ADT in the ADT group was 12 (range 8-25) months. In the ADT group, the median BNP level after ADT was 23.1 pg/ml, which was significantly higher than that before ADT (p < 0.01). In the control group, the median BNP level before RP was 12.8 pg/ml, showing no significant change from that before prostate biopsy (p = 0.54).

Conclusions

The current study demonstrated a significant increase in BNP levels after short-term ADT in patients with prostate cancer, which might reflect the adverse impact of ADT on cardiac function.

Funding

none