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Androgen Deprivation Therapy and the Risk of Anemia in Men with Prostate Cancer

Hicks, Blánaid M.a,b; Klil-Drori, Adi J.a,b; Yin, Huia; Campeau, Lysannec; Azoulay, Laurenta,b,d

doi: 10.1097/EDE.0000000000000678
Cancer
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SDC

Background: The use of androgen deprivation therapy in prostate cancer may be associated with an increased risk of anemia, but the evidence remains limited. This study aimed to determine if androgen deprivation is associated with increased risk of anemia in patients newly diagnosed with prostate cancer.

Methods: This was a population-based cohort study using the United Kingdom Clinical Practice Research Datalink linked to the Hospital Episode Statistics repository. The cohort consisted of 10,364 men newly diagnosed with nonmetastatic prostate cancer between 1 April 1998 and 30 September 2015. We used time-dependent Cox proportional hazards models to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for anemia (hemoglobin <130 g/L) associated with current and past use of androgen deprivation therapy, compared with nonuse.

Results: There were 3,651 incident anemia events during 31,574 person-years of follow-up (rate: 11.6/100 person-years). Current androgen deprivation therapy use was associated with a nearly three-fold increased hazard of anemia, compared with nonuse (23.5 vs. 5.9 per 100 person-years, respectively; HR: 2.90, 95% CI: 2.67, 3.16). The HR was elevated in the first 6 months of use (HR: 2.20, 95% CI: 1.95, 2.48) and continued to be elevated with longer durations of use. Past androgen deprivation therapy use was associated with a lower estimate (HR: 1.27, 95% CI: 1.12, 1.43), which returned closer to the null ≥25 months after treatment discontinuation (HR: 0.95, 95% CI: 0.79, 1.15).

Conclusions: The use of androgen deprivation therapy is associated with increased risk of anemia, which reverses upon treatment discontinuation.

From the aCentre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, QC, Canada; bDepartment of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, QC, Canada; cDivision of Urology, Department of Surgery, McGill University, Montréal, QC, Canada; and dGerald Bronfman Department of Oncology, McGill University, Montréal, QC, Canada.

Submitted 19 August 2016; accepted 14 April 2017.

Funded by a Foundation Grant from the Canadian Institutes of Health Research. The funding source had no influence on design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript.

The authors report no conflicts of interest.

Supplemental digital content is available through direct URL citations in the HTML and PDF versions of this article (www.epidem.com).

Correspondence: Laurent Azoulay, Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Sainte-Catherine, H-425.1, Montreal, QC H3T 1E2, Canada. E-mail: laurent.azoulay@mcgill.ca.

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