Race and association between ADT and adverse events.

5073 Background: Many prior studies have linked androgen deprivation therapy (ADT) for prostate cancer (PC) with adverse events such as cardiac events and osteoporosis. Whether these associations differ by race is unknown. Methods: We performed a retrospective population-level analysis to assess the association between ADT (specifically GnRH agonist) use and time to cardiovascular events, bone fracture, new osteoporosis diagnosis, or time to composite event (i.e., the first of any of cardiovascular, bone fracture, or osteoporosis events) in the Veterans Affairs Health Care System (VA) as a function of race. We identified 790,916 patients from 2001-2021 who were diagnosed with PC and treated with ADT or no ADT. Given small numbers, patients treated with other forms of ADT including bilateral orchiectomy or GnRH antagonists were excluded. Patients were also excluded if they were missing race/ethnicity. Data were stratified by race/ethnicity including: Non-Hispanic White (White) 598,574, Non-Hispanic Black (Black) 145,267, Hispanic 30,139 and Other 16,936. Univariable and multivariable Cox proportional hazards models were used to test the association between ADT as a time-dependent covariate and time to the given event across all patients and as a function of race. Results: On multivariable analysis among all patients, ADT was associated with increased risk of cardiovascular events (HR 1.16, 95% CI 1.15- 1.17, p<0.001), bone fractures (HR 1.59, 95% CI 1.55-1.62, p<0.001), osteoporosis (HR 2.73, 95% CI 2.65-2.80, p<0.001), and composite event (HR 1.29, 95% CI 1.27-1.30, p <0.001). When stratified by race, ADT remained significantly associated with all outcomes in all races (all p<0.001). Compared to White men, among Black men, the HRs for ADT were slightly lower for cardiovascular events (1.09 vs. 1.18), bone fracture (1.35 vs 1.65), and composite event (1.19 vs 1.31), but slightly higher for osteoporosis (3.16 vs 2.64). HRs in Hispanics and Other races were very similar to those in White men. Conclusions: Consistent with many prior studies, we found that ADT was associated with increased risk of cardiovascular events and bone complications. Though risks differed slightly among Black men, overall differences were small. These findings demonstrate that ADT is associated with adverse cardiovascular and bone complications regardless of race. Better means to reduce ADT-associated risks are needed across all races.