AUGUSTA, GA — The standard treatment for advanced prostate cancer (PC) is androgen deprivation therapy (ADT), usually delivered via a luteinizing hormone-releasing hormone (LHRH) agonist.
“While quite effective, it has been associated with an increased risk of major adverse cardiovascular events (MACE),” according to the authors from the Medical College of Georgia in Augusta, GA, and colleagues, including participation from the Durham, NC, VA Healthcare System. “The exact mechanisms are not clear. However, it has been theorized that follicle-stimulating hormone (FSH), a pituitary hormone that is involved in controlling normal testosterone levels, which is decreased with LHRH-agonist therapy, may be the culprit.”
An article in Translational Andrology and Urology described how the study team performed a retrospective population-level study to test the link of FSH levels on the development of MACE and castrate-resistant PC (CRPC), as well as death, among men starting ADT.
Using data from the VA health system, researchers identified 1,539 men who had an FSH level between 1999 and 2018 within two years prior to starting ADT. “FSH was dichotomized as low/normal (≤8 IU/mL) and high (>8 IU/mL), using established cut-points,” the authors explained. “The associations between FSH and time to MACE, death, and CRPC were tested using log-rank tests and multivariable Cox proportional hazards models.”
The study found that patients with high FSH were older (median 76 vs. 73 years, P<0.001), started ADT earlier (median 2007 vs. 2009, P=0.027), and had lower body mass index (BMI) (median 29.1 vs. 30.1 kg/m2,1 P=0.004) compared to those with low/normal FSH. “On multivariable analysis, there was no association between FSH and time from ADT to MACE, CRPC, or death,” according to the results.
The researchers concluded that, in this population-level study of men receiving an FSH test prior to starting ADT, there was no association between FSH levels and time from ADT to MACE, CRPC or death. “Although further studies are needed, these results do not support a link between pre-ADT FSH and long-term oncological or cardiovascular outcomes,” they added.
- Dymanus K, Friedrich NA, Howard LE, Oyekunle et. al. Are higher follicle-stimulating hormone levels before androgen deprivation therapy for prostate cancer associated with oncological and cardiac outcomes and overall survival?-a population-level analysis. Transl Androl Urol. 2023 Oct 31;12(10):1540-1549. doi: 10.21037/tau-23-114. Epub 2023 Oct 16. PMID: 37969776; PMCID: PMC10643384.