LAUSR

Androgen deprivation therapy (ADT) is a central part of prostate cancer treatment. Although medical castration using gonadotropin-releasing hormone (GnRH) agonists or antagonists might soften the mental or physical burden caused by surgical castration, an increase in the risk of cardiovascular disease has been reported. There are apparent differences between GnRH agonists and antagonists on the mechanism of action. GnRH antagonists act as a competitive inhibitor of GnRH. Unlike GnRH agonists, the antagonists do not cause an initial surge of gonadotropins. Kijima et al. attempted to evaluate the adverse effects of GnRH agonists and antagonists on cardiac function by examining brain natriuretic peptide (BNP). BNP is a peptide hormone that is released in response to volume expansion and the increased wall stress of cardiac myocytes. BNP is a sensitive biomarker for diagnosing heart failure. The plasma BNP levels of 86 patients were measured before carrying out ADT and 6 months after ADT, and the changes of the BNP levels were analyzed. The 41 patients who received antagonists showed no changes of BNP levels, whereas the 45 who received agonists showed a significant increase in BNP levels after treatment (P < 0.01). Cardiovascular events were observed in one of the patients who received antagonists, and in two of the patients who received agonists. The difference is insignificant. The mean age of the antagonists group was significantly higher than that of the agonists group. Except for the age, there were no other differences in patient characteristics, comorbidities and history of cardiovascular disease between the two groups. The findings showed that GnRH agonists caused a significant increase in BNP levels, but antagonists did not seem to be useful in clinical practice. The risk of cardiovascular disease should be considered for the selection of ADT.