Comparison of cardiovascular events in patients with metastatic hormone sensitive prostate cancer treated with LHRH agonists to LHRH antagonists in the US: A retrospective cohort study.

Titus RS, Velasquez EL, Mundra V, +9 more, Satkunasivam R.

IMAbstract only — full text under license

AI summary — for doctors, generated from the abstract only

In a TriNetX analysis, LHRH agonists were associated with fewer major cardiovascular events than antagonists in metastatic hormone-sensitive prostate cancer, a result that runs against common assumptions.

What was studied

Retrospective propensity-matched cohort (3,329 per arm after matching from 27,051 agonist and 3,339 antagonist patients) comparing MACE (myocardial infarction, stroke or all-cause death).

Key findings

Agonists were associated with lower MACE (HR 0.86, 95% CI 0.79-0.93)
Lower myocardial infarction (HR 0.80, 95% CI 0.66-0.97) and mortality (HR 0.85, 95% CI 0.78-0.93)
Treatment intensification did not modify the MACE association

Clinical relevance

The data should not prompt switching on their own, but cardiovascular risk deserves attention in ADT selection.

Who should care

Urology

Limitations

Retrospective database study with residual confounding, including confounding by indication and mortality driving the composite; no randomization.

Association only; this contradicts the antagonist cardiovascular-safety hypothesis and needs prospective data.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

Androgen deprivation therapy (ADT) is standard treatment for metastatic hormone-sensitive prostate cancer (mHSCaP). Patients receive LHRH-agonists (LHRH-AG: leuprolide, goserelin or triptorelin) or LHRH-antagonists (LHRH-AN: degarelix or relugolix) with intensification with androgen receptor pathway inhibitors, with or without chemotherapy. Given ongoing concerns about cardiovascular risk, we used real-world data from TriNetX to compare the incidence of major adverse cardiovascular events (MACE) between patients receiving LHRH-AG vs. LHRH-AN. We included adult patients with mHSCaP who received either an LHRH-AG or LHRH-AN. The composite primary outcome was MACE (defined as myocardial infarction (MI), stroke, or all-cause mortality). Secondary outcomes were MI, stroke, and all-cause mortality. Patients were 1:1 propensity-score matched (PSM). Kaplan-Meier analysis reporting hazard ratios (HR) and 95% confidence intervals (CI) for the outcomes was conducted. We conducted a subgroup analysis to assess the effect of intensification of therapy. Exploratory analyses were conducted to assess HR of outcomes and new-onset metabolic comorbidities (diabetes mellitus, insulin use, hypertension, and dyslipidemia) amongst patients without cardiovascular risk factors. Before PSM, there were 27,051 in LHRH-AG and 3,339 in LHRH-AN cohorts. After PSM, 3,329 patients in each cohort were compared. Compared to LHRH-AN, LHRH-AG was associated with a decreased risk of MACE (hazard ratio [HR] = 0.86, 95% CI: 0.79-0.93), MI (HR = 0.80, 95% CI: 0.66-0.97), and any-cause mortality (HR = 0.85, 95% CI: 0.78-0.93). Treatment intensification did not modify the association between MACE outcomes and LHRH-AG vs. LHRH-AN. Using real-world data, LHRH-AG was associated with a decreased risk of experiencing MACE. Among those undergoing intensification of therapy, there was no difference in MACE risk associated with LHRH-AG vs. LHRH-AN.

DOI

10.1016/j.urolonc.2026.09.012

PMID

42892580

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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