Androgen Deprivation Therapy Is Associated With Prolongation of QTc Interval in Men With Prostate Cancer

J Endocr Soc. 2018 Apr 20;2(5):485-496. doi: 10.1210/js.2018-00039. eCollection 2018 May 1.


Context: Androgen deprivation therapy (ADT) for prostate cancer (PCa) is associated with increased cardiovascular mortality and sudden cardiac death, with some events occurring early after initiation of ADT. Testosterone levels are inversely associated with corrected QT (QTc) interval duration; therefore, prolongation of QTc duration could be responsible for some of these events during ADT.

Objective: To evaluate changes in QTc duration during ADT.

Design and interventions: A 6-month prospective cohort study that enrolled men with PCa about to undergo ADT (ADT group) and a control group of men who previously underwent prostatectomy for PCa and never received ADT (non-ADT group).

Patients: At study entry, all participants were eugonadal and had no history of cardiac arrhythmias or complete bundle branch block.

Outcomes: Difference in change in QTc duration from baseline on a 12-lead electrocardiogram at 6, 12, and 24 weeks after initiation of ADT compared with electrocardiograms performed at the same intervals in the non-ADT group. PR, QRS, and QT interval durations were also evaluated.

Results: Seventy-one participants formed the analytical sample (33 ADT and 38 non-ADT). ADT was associated with prolongation of the QTc by 7.4 ms compared with the non-ADT group [95% confidence interval (CI) 0.08 to 14.7 ms; P = 0.048]. ADT was also associated with shortening of the QRS interval by 2.4 ms (95% CI -4.64 to -0.23; P = 0.031). Electrolytes did not change.

Conclusions: Men undergoing ADT for PCa experienced prolongation of the QTc. These findings might explain the increased risk of sudden cardiac death seen in these patients.

Keywords: ECG; GnRH agonist; QT interval; arrhythmia; cardiovascular risk; testosterone.