Background: There is increasing recognition that androgen deprivation therapy for prostate cancer leads to adverse cardiometabolic risk, accelerated bone and muscle loss, as well as decreased quality of life. Dedicated ADT clinics to proactively mitigate adverse side-effects arising from the profound hypogonadism are effective at lowering cardiovascular risk factors and optimising bone health1. We aimed to evaluate the number of individuals referred to such a clinic over time and assess their baseline cardiovascular risk factors.
Methods: We conducted a prospective cohort study of men with prostate cancer newly commencing ADT referred to a dedicated ADT Clinic at a tertiary referral hospital (Austin Health, Victoria) between March 2007 and December 2016. All patients commenced on long-term ADT for high risk prostate cancer at Austin Health are referred to this clinic. Patient characteristics and co-morbidities at presentation were reported using descriptive statistics, namely median and range for continuous variables and percentages of patients for categorical variables.
Results: 555 individuals were included in the analysis. Of these 352 had an initial assessment within 6 months of commencing ADT. The number of men commencing ADT peaked in 2011 and has steadily declined thereafter (see Figure 1). At baseline, median age was 70 years (range 49-91), 62% had hypertension, 56% hypercholesterolemia, 80% overweight/obesity (BMI>25kg/m2), 21% diabetes mellitus, 23% ischaemic heart disease, and 50% had a smoking history.
Conclusion: Decrease in number of individuals commenced on ADT over the last 5 years may reflect decrease in use of PSA as a screening modality for detecting prostate cancer, increasing recognition regarding adverse risks of ADT, or potentially a shift towards use of robotic assisted prostatectomy as primary treatment for high risk prostate cancer over combination radiotherapy and ADT. Baseline cardiovascular risk factors remain highly prevalent amongst this cohort.