Comorbidity and androgen deprivation therapy use in men undergoing high-dose radiation for unfavorable-risk prostate cancer

Because survival may be shortened in prostate cancer (PC) patients with moderate/severe comorbidity receiving androgen deprivation therapy (ADT), we explored if comorbidity predicts ADT use in those with unfavorable-risk PC. Between 10/1997 and 5/2013, 3366 men with unfavorable-intermediate- (70.7 %) or high-risk (29.3 %) PC were treated at the Chicago Prostate Cancer Center using brachytherapy with/without neoadjuvant external-beam radiation therapy (EBRT) and/or ADT. Multivariable logistic regression analysis was performed to evaluate whether history of heart failure and/or myocardial infarction (CHF/MI) was associated with decreased odds of ADT use in men with unfavorable-intermediate- or high-risk PC, adjusting for age, PC prognostic factors, year of brachytherapy, and EBRT use. Among patients with unfavorable-intermediate-risk PC, 31.2 % received ADT. Among those with high-risk PC, 38.3, 12.3, and 4.8 % received > 0-6, > 6-18, and > 18 months of ADT, respectively. In men with unfavorable-intermediate-risk PC, history of CHF/MI was not significantly associated with decreased odds of ADT use (p = 0.49), but odds of ADT use decreased significantly over the study period, i.e., by year of brachytherapy (adjusted odds ratio [95 % confidence interval] (AOR [95%CI]) = 0.96 [0.94, 0.98], p = 0.0009). Similarly, in men with high-risk PC, history of CHF/MI was not significantly associated with odds of decreased ADT duration (all p values > 0.71), but odds of ADT use of various durations decreased over the years of the study period (AOR [95%CI] = 0.87 [0.83, 0.91], p < 0.0001; AOR [95%CI] = 0.93 [0.87, 0.99], p = 0.023; and AOR [95%CI] = 0.92 [0.83, 1.01], p = 0.089, for > 0-6; > 6-18; and > 18 months of ADT use, respectively, compared to no ADT). While neoadjuvant ADT use decreased over the study period in men with unfavorable-risk PC undergoing brachytherapy, ADT use was not less likely in those with a history of CHF/MI.