br Conclusion br Prostate cancer

Conclusion

Prostate cancer (PC) is the second most common diagnosed malignancy in men worldwide, with an estimated 1.1 million cases reported in 2012. Androgen deprivation therapy (ADT) is the standard treatment for aggressive and advanced PC. ADT includes an orchiectomy, estrogens, antiandrogens, luteinizing hormone-releasing hormone (LHRH) agonists and antagonists.
Plenty of studies have demonstrated that ADT can improve disease-free and overall survival when used in combination with radiation for patients with locally advanced PC. However, androgens are an important part of the body composition in males as they support lean body mass over fat mass. One study indicated that LHRH agonist therapy increased fat mass by 10% and decreased lean body mass by 3% and also the associated sarcopenic obesity. The reduced muscle mass may be related to the risk of falls.
Globally, falls are the major cause of accidental or unintentional injury and deaths. However, previous findings rarely examined the association between ADT and the risk of falls. To fill in this gap in the literature, the present study aimed to examine the relationship between the use of ADT and the subsequent risk of falls in men with PC by employing a population-based dataset in Taiwan.
Methods

Results
Table 1 shows the distribution of demographic characteristics of PC patients according to the use of ADT. We found that PC patients who had received ADT were more likely to be older than those who had not received ADT (74.2 years vs 70.5 years, P <.001). In addition, there were significant differences in geographic region and monthly income between PC patients who had received ADT and those who had not (both P < .001). However, there was no significant difference in the prevalence of comorbidities of hypertension, diabetes, hyperlipidemia, coronary l-name disease, Parkinson\’s disease, epilepsy, and mental illness between these 2 groups. In addition, the mean length of ADT therapy for PC patients who had received ADT was 524 (±439) days during the 3-year follow-up period.
Table 2 presents the incidence of falls among the sampled patients. Among the total sampled patients, the incidence rate of falls per 1000 person-years was 9.99 (95% CI: 7.32~13.24). The incidence rates of falls per 1000 person-years were 13.37 (95% CI: 9.15~18.88) and 6.44 (95% CI: 3.61~10.63), respectively, for PC patients who had received ADT and those who had not received ADT. The log-rank test suggested that PC patients who had received ADT were more likely to have a fall incidence than those who had not received ADT (P = .016). Furthermore, Table 2 reveals that after censoring sampled patients who died during the 3-year follow-up period, the HR for a fall in PC patients who had received ADT was 2.12 (95% CI: 1.14~3.94) compared to those who had not received ADT.
Furthermore, Table 3 shows the adjusted HR for a fall during the 3-year follow-up period between the 2 groups. Cox proportional hazard regressions suggested that the HR for a fall during the 3-year follow-up period for PC patients who had received ADT was 1.95 (95% CI: 1.04~3.66, P = .037) compared to those who had not received ADT after censoring sampled patients who died during the 3-year follow-up period and adjusting for age, geographical location, monthly income, urbanization level, hypertension, diabetes, hyperlipidemia, coronary heart disease, Parkinson\’s disease, epilepsy, stroke, and mental illness.

Discussion
Prior studies have reported that ADT may lead to a hypogonadal condition, reduce the quality of life, cause or exacerbate anemia, increase risk for diabetes, and cognitive alterations. The present findings suggest that PC patients who had received ADT had an increased risk of falls. This study found that that the adjusted HR for a fall during the 3-year follow-up period for PC patients who had received ADT was 1.95 (95% CI: 1.04~3.66) compared to those who had not received ADT.