ESMO Asia Virtual Congress 2020

Abstract 224P

Background

Research has largely focused on the effect of prior androgen deprivation therapy on the subsequent risk of CVD in patients with metastatic prostate cancer. However, the impact of pre-existing CVD on localized prostate cancer treatments and outcomes is unknown. This study aimed to identify the associations of baseline CVD with treatment patterns and survival outcomes in localized prostate cancer.

Methods

We identified patients diagnosed with localized prostate cancer in a large Canadian province from 2004-2017 using the population-based registry. Administrative sources were linked to ascertain any diagnoses of CVD (including myocardial infarctions [MIs], congestive heart failure [CHF], cerebrovascular accidents [CVAs] and arrythmias [AR]) prior to the onset of prostate cancer. Logistic regression and Cox regression were used to determine the associations of baseline CVD with cancer treatments (receipt of surgery and radiotherapy) and overall survival (OS).

Results

A total of 23,670 patients were included. The median age was 65 years (interquartile range, 38-97 years). Of these, 16.4%, 71.1% and 12.5% patients had stage I, II and III prostate cancer, respectively. At the diagnosis of prostate cancer, 4860 (20.5%) had pre-existing CVD: 6.0% AR, 3.4% CVAs, 3.0% MIs, 1.8% CHF and 6.4% multiple CVDs. The Charlson comorbidity index (CCI) was 0, 1 and >1 in 55.3%, 25.4% and 19.3%. After adjusting for age, stage and CCI, pre-existing CVD was associated with a lower likelihood of surgery (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.81-0.95; P=0.001), but not radiotherapy (OR, 0.96; 95% CI, 0.88-1.04; P=0.319). Likewise, CVD was associated with worse OS, after adjusting for measured confounding variables (Table). Table: 224P

	Hazard ratio	95% confidence interval	P-value
Age at diagnosis < 65 > 65	Ref 3.55	3.29-3.83	<0.001
Stage at diagnosis I II III	Ref 1.33 1.52	1.18-1.51 1.30-1.77	<0.001 <0.001
Surgery No Yes	Ref 0.59	0.55-0.63	<0.001
Radiotherapy No Yes	Ref 0.52	0.48-0.56	<0.001
Baseline cardiovascular disease No Yes	Ref 1.97	1.85-2.10	<0.001

Conclusions

One-fifth of patients with localized prostate cancer have pre-existing CVD, which was associated with a lower likelihood of surgery and worse OS. In the context of an aging general population, this may have implications for radiotherapy capacity planning as more patients are offered non-surgical therapies. Early cardio-oncology consultations may optimize the management of CVD and allow for better uptake of prostate cancer treatments.