Androgen Deprivation Therapy for Prostate Cancer and the Risk of Hospitalisation for Community-Acquired Pneumonia

Date of Approval: 
2016-07-28 00:00:00
Lay Summary: 
Prostate cancer is the most common cancer diagnosed among males in the UK, with 47,000 new cases each year. Androgen deprivation therapy (ADT), which lowers levels of the hormone testosterone, is the main treatment for patients with advanced prostate cancer. However ADT has been associated with a number of negative side effects such as stroke and fractures. There is also some evidence that ADT may cause a decrease in white blood cells, which are the primary defense against infections. Limited studies to date have investigated the risk of pneumonia, a common infection that affects the lungs, in patients using ADT and these studies have a number of limitations. Pneumonia is of particular concern in older adults, particularly those with cancer, for whom severe pneumonia often results in hospitalisations and may cause death. Thus, the purpose of this study is to determine whether ADT is associated with an increased risk of pneumonia in patients with prostate cancer.
Technical Summary: 
Androgen deprivation therapy (ADT) is the mainstay treatment in patients with advanced prostate cancer. However, this therapy has been associated with a number of adverse events, including cardiovascular outcomes and fractures. Studies also suggest that ADT may increase the risk of pneumonia, but these have a number of methodological shortcomings. Thus, the objective of this study is to assess whether the use of ADT (including gonadotropin-releasing hormone (GnRH) agonists, oral antiandrogens, and bilateral orchiectomy) is associated with an increased risk of community-acquired pneumonia. This objective will be addressed by assembling a cohort of patients newly-diagnosed with non-metastatic prostate cancer between April 1, 1998 and March 31, 2015. Time-dependent Cox proportional hazard models will be used to estimate adjusted hazard ratios and 95% confidence intervals for a hospitalisation for community-acquired pneumonia (recorded in the Hospital Episode Statistics) associated with current and past use of ADT, compared with no use. Secondary analyses will assess if the risk varies according duration of use, and by specific types of ADT.
Health Outcomes to be Measured: 
Hospitalisation for community-acquired pneumonia
Application Number: 

Samy Suissa - Chief Investigator - McGill University
Blanaid Hicks - Collaborator - Queen's University Belfast
Christina Santella - Collaborator - McGill University
Hui Yin - Collaborator - Sir Mortimer B Davis Jewish General Hospital
Laurent Azoulay - Collaborator - McGill University
Pierre Ernst - Collaborator - McGill University

HES Admitted Patient Care