To the Editor: In the study by Dr Nanda and colleagues,1 although the adjusted hazard ratio for all-cause mortality with neoadjuvant androgen deprivation therapy (ADT) was less than 1.0 in men without comorbidities, the absolute death rate was higher in men who received neoadjuvant ADT (9.6%) than in men who did not (6.7%). Although the authors state that this can be explained by the more unfavorable prostate cancer prognostic factors for the neoadjuvant ADT group, the possibility that ADT promoted castration-refractory disease and all-cause mortality cannot be ruled out.
Agarwal N. Hormonal Therapy for Prostate Cancer in Men With Heart Disease. JAMA. 2010;303(1):32-33. doi:10.1001/jama.2009.1931