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Original article
Androgen deprivation therapy for prostate cancer and the risk of hospitalisation for community-acquired pneumonia
  1. Blánaid M Hicks1,2,
  2. Hui Yin1,
  3. Franck Bladou3,4,
  4. Pierre Ernst1,5,
  5. Laurent Azoulay1,2,6
  1. 1Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montréal, Quebec, Canada
  2. 2Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
  3. 3Department of Urology, Jewish General Hospital, Montréal, Quebec, Canada
  4. 4Division of Urology, McGill University, Montréal, Quebec, Canada
  5. 5Department of Medicine, McGill University, Montréal, Quebec, Canada
  6. 6Gerald Bronfman Department of Oncology, McGill University, Montréal, Quebec, Canada
  1. Correspondence to Dr Laurent Azoulay, Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Sainte-Catherine, H-425.1, Montreal, Quebec, Canada H3T 1E2; laurent.azoulay{at}mcgill.ca

Abstract

Background Androgens have been shown to influence both the immune system and lung tissue, raising the hypothesis that androgen deprivation therapy (ADT) for prostate cancer may increase the risk of pneumonia. Thus, the aim of this study was to determine whether ADT is associated with an increased risk of hospitalisation for community-acquired pneumonia in patients 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 20 310 men newly diagnosed with non-metastatic prostate cancer between 1 April 1998 and 31 March 2015. Time-dependent Cox proportional hazards models were used to estimate adjusted HRs and 95% CIs for hospitalisation for community-acquired pneumonia associated with current and past use of ADT compared with non-use.

Results During a mean follow-up of 4.3 years, there were 621 incident hospitalisations for community-acquired pneumonia (incidence rate: 7.2/1000 person-years). Current ADT use was associated with an 81% increased risk of hospitalisation for community-acquired pneumonia (12.1 vs 3.8 per 1000 person-years, respectively; HR 1.81, 95% CI 1.47 to 2.23). The association was observed within the first six months of use (HR 1.73, 95% CI 1.23 to 2.42) and remained elevated with increasing durations of use (≥25 months; HR 1.79, 95% CI 1.39 to 2.30). In contrast, past ADT use was not associated with an increased risk (HR 1.23, 95% CI 0.95 to 1.60).

Conclusions The use of ADT is associated with an increased risk of hospitalisation for community-acquired pneumonia in men with prostate cancer.

  • Pneumonia
  • Clinical Epidemiology

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Footnotes

  • Contributors All authors conceived and designed the study, analysed and interpreted the data, and critically revised the manuscript for important intellectual content. LA acquired the data. BMH, HY, FB, PE and LA did the analyses. BMH wrote the manuscript and all authors participated in the interpretation of the results and critical revision of the manuscript. LA is the guarantor.

  • Funding This study was funded by a Foundation Grant from the Canadian Institutes of Health Research.

  • Competing interests None declared.

  • Ethics approval The study protocol was approved by the Independent Scientific Advisory Committee of the Clinical Practice Research Datalink (protocol number 16_144) and by the Research Ethics Board of Jewish General Hospital, Montreal, Quebec, Canada.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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