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.

Authors

Renil S Titus, Eusebio Luna Velasquez, Vatsala Mundra, Carlos Riveros, Sanjana Ranganathan, David-Dan Nguyen, Amar Singh, Aamuktha Porika, Dharam Kaushik, Kershaw V Patel, Eleni Efstathiou, Christopher J D Wallis, Raj Satkunasivam

Published in

Urologic oncology. Oct 18, 2026. Epub Oct 18, 2026.

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.

PMID:
42892580
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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