(198) MID-TERM DETERIORATION OF ENDOTHELIAL FUNCTION AND METABOLIC PARAMETERS FOLLOWING ONE-YEAR ANDROGEN DEPRIVATION THERAPY IN MEN WITH PROSTATE CANCER
Authors: Cintra AR , Linhares BL , Da Rocha EL , Monteiro MMF , Da Trindade KM , Lopes MSR , Linhares-Filho JPP , Bessa Jr. J , Miranda EDP , Reges R 
Published: December 2024

Abstract

Introduction
Androgen deprivation therapy (ADT) is a standard treatment for advanced prostate cancer. Although ADT delays cancer progression and alleviates cancer-related symptoms, this treatment is related to metabolic derangement and increase of cardiovascular risk. Despite the well-established association between the levels of circulating testosterone and endothelial integrity, the short to mid-term effects of ADT on vascular endothelial function are not completely understood.

Objective
Our aim was to evaluate the impact on endothelial function after one year of ADT, through the analysis of vascular parameters of the brachial artery, and the measurement of serum inflammatory markers. We also investigated the effects of this treatment on body composition and metabolic parameters.

Methods
We prospectively evaluated men with moderate to high-risk prostate cancer treated with ADT from January 2022 to January 2024 at our institution. Smokers and those who stopped smoking less than five years ago, decompensated diabetics (glycated hemoglobin &gt;9%) and those who had already had a cardiovascular event were excluded. Ultrasound was used to assess vascular diameter and flow-mediated (FMD) endothelium-dependent brachial artery vasodilation. Metabolic and inflammatory profile included serum measurement of total cholesterol and fractions, triglycerides, fasting glucose, glycated hemoglobin, basal insulin, C-reactive protein, and bioelectrical impedance assessment of body fat distribution. Individuals were evaluated prior to ADT with goserelin acetate 10.80 mg and after 3 and 12 months of therapy, for those who remained on ADT for this entire timeframe. Difference between groups was analyzed using anova test.

Results
32 men were evaluated in two visits (baseline and 3 months). From the initial group of patients, 18 men were also evaluated in a third visit (12 months). The mean age was 69 years and prevalence of diabetes was 31,25%. There was no significant change in FMD after 12 months of ADT (p = 0.25). The baseline diameter of the brachial artery demonstrated significant worsening after one year of ADT (p = 0.004) (Fig. 1). With regard to the metabolic profile, ADT significantly increased insulin resistance: fasting insulin levels (p = 0.03) and homeostatic model assessment insulin resistance (p = 0.04) increased significantly after 12 months. Total cholesterol and triglyceride concentrations were higher after 12 months of ADT (p = 0.04 and p = 0.03, respectively) (Fig. 2). There was a significant decrease in HDL after 12 months of treatment (p &lt; 0.0001). Abdominal circumference, weight and body fat percentage increased significantly after ADT (p = 0.01; p &lt; 0.0001; p = 0.006; respectively). After one year, there was a significant increase in blood pressure, both systolic (p = 0.02) and diastolic (p = 0.003).

Conclusions
Although the present study did not demonstrate a significant change in brachial artery FMD, we found a significant worsening of blood pressure, arterial diameter and metabolic profile with ADT, especially an increase in insulin resistance, dyslipidemia and abdominal circumference, which represent well-established risk factors for cardiovascular events.

Disclosure
No.