3298 - Cardiovascular Disease and Diagnosis of Advanced Prostate Cancer

12:45pm - 02:00pm PT

Hall F

Screen: 18

POSTER

Presenter(s)

Kevin Nead, MD, MPhil - The University of Texas MD Anderson Cancer Center, Houston, TX

K. T. Nead¹, A. Haas², J. Zhao¹, T. Xiong³, C. Tang⁴, S. Giordano², and N. Leeper³; ¹Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX, ²Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, ³Department of Vascular Surgery, Stanford University School of Medicine, Stanford, CA, ⁴Department of Genitourinary Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

Purpose/Objective(s): Mechanistic data supports a causal association between cardiovascular disease (CVD) and cancer. For example, induced myocardial infarction (MI) in models of intestinal adenomas results in increased tumor burden secondary to cardiac secreted factors. Similarly, induced MI in models of breast cancer results in increased proliferative index, primary tumor volume, and metastatic spread, secondary to immunosuppression. Building on this work, we subsequently conducted a population level analysis and demonstrated that individuals with advanced breast cancer at diagnosis (T3-4 or N+ or M+) were more likely to have pre-diagnosis CVD. As this finding was limited to less aggressive subtypes (HR-, HER2-), we hypothesized that CVD may be a particular risk factor in more indolent cancer histologies. Here we therefore extend our prior work by testing the hypothesis that individuals with prevalent CVD are more likely to present with advanced prostate cancer at diagnosis.

Materials/Methods: We utilized Surveillance, Epidemiology, and End Results-Medicare to identify men with prostate cancer diagnosed from 2010-2019, =67 years, with =2 healthcare interactions and PSA screening in the 3-24 months pre-diagnosis. We conducted 1:3 propensity score matching utilizing factors associated with delayed cancer diagnosis. We compared prevalent CVD status among individuals with and without advanced prostate cancer (T3-4 or N+ or M+), and by Gleason score (<8 vs. =8), at diagnosis. We implemented conditional logistic regression adjusting for matching variables and comorbid conditions.

Results: We included 12,120 individuals with median age 75 years (IQR 71-80), including 903 Black (7.5%) and 10,659 White (87.9%) individuals, with 7,127 (58.8%) having prevalent CVD. Compared to men with localized prostate cancer, individuals diagnosed with advanced prostate cancer had a 10% increased odds of prevalent CVD (OR, 1.10; 95% CI, 1.03-1.17; p=0.007). This finding was limited to individuals with metastatic disease at diagnosis (N+ or M+; OR, 1.19; 95% CI, 1.05-1.34; p=0.006). We also found that individuals with Gleason score =8, versus <8, had a 7% increased odds of prevalent CVD (OR, 1.07; 95% CI, 1.01-1.13; p=0.020).

Conclusion: We demonstrate that men with CVD have a greater risk of advanced prostate cancer at diagnosis, specifically metastatic (N+ or M+) and high Gleason score (=8) disease. These data bolster mechanistic work and our prior population level studies demonstrating an association of CVD with cancer incidence and severity at diagnosis. As prostate cancer screening guidelines recommend shared decision-making, our results provide important data for personalized screening recommendations.