In Reply: The physiological effects of ADT typically persist long after cessation of treatment, particularly in men older than 70 years who comprised the majority of patients in the trials included in our meta-analysis. Testosterone suppression often persists for 2 or more years after ADT is stopped.1-3 Thus, the interval between ADT-induced testosterone suppression and data collection is actually shorter than it may appear. However, our study cannot rule out the possibility that fatal cardiac events could be occurring earlier in men exposed to ADT.
Nguyen PL, Je Y, Choueiri TK. Androgen Deprivation Therapy for Prostate Cancer and Cardiovascular Death—Reply. JAMA. 2012;307(12):1252–1253. doi:10.1001/jama.2012.353
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