Prostate cancer is one of the most common cancers among men, affecting about one in six men in the United States. It is usually a very slow-growing disease, taking years to spread beyond the gland and pose a serious health threat. Once the cancer has spread beyond the prostate gland it can no longer be cured, but it can be slowed down by injecting the patient with drugs that block the supply of testosterone, a male hormone that directly stimulates the growth of both normal prostate tissue and prostate cancer cells. The treatment, known as hormone therapy or HT, can increase survival in more advanced cases of prostate cancer when used with surgery or radiation. But the side effects are unpleasant: hot flashes, erectile dysfunction, bone loss, memory problems, fatigue and loss of interest in sex. And, according to a new study, it may be dangerous for some men with heart disease—doubling their risk of death.
Dr. Anthony D’Amico of Brigham and Women’s Hospital and the Dana-Farber Cancer Institute in Boston and colleagues studied 5,077 cases of men, average of about 70, diagnosed with localized or locally advanced prostate cancer between 1997 and 2006. All the men were treated with radiation therapy and 30 percent of them also took HT for an average of four months. Over a median follow-up of five years, 419 of the men died. Of those, 200 had no underlying cardiac conditions or risk factors, 176 had one coronary artery disease factor, such as high blood cholesterol, and 43 had suffered from heart failure or had a heart attack.
Analysis of the data showed that, when considering comorbidity groups separately, HT caused no increased risk of all-cause mortality in men with no co-existing conditions (9.6 percent vs. 6.7 percent) or those with a single coronary artery disease risk factor (10.7 percent vs. 7.0 percent). However, for those with a history of serious heart problems, HT was associated with nearly twice the risk of all-cause mortality (26.3 percent vs. 11.2 percent). “Our results should heighten awareness about the potential for harm with hormonal therapy for men with pre-existing heart disease,” said study author Dr. Akash Nanda of the Harvard Radiation Oncology Program in Boston. “The risks need to be balanced with the benefits. For more advanced disease, the primary treatment is a combination of hormone therapy and radiation. So, for them, it becomes a little more tricky.”
Some experts agree that co-existing heart conditions should be taken into account when deciding which treatment best suits a patient. “I think this is going to make people even more conservative in their use of hormones than when researchers started to identify who benefited,” said Dr. Eric M. Horwitz, acting chairman of the radiation oncology department at Fox Chase Cancer Center in Philadelphia. “We had always thought that there might be cardiac problems with long-term use of hormones, but this shows that even a short course can be harmful.”
For other experts, the findings weren’t unexpected. “For those who’ve been following the field, this is not surprising at all,” said Dr. Stephen Freedland, a Duke University prostate cancer specialist. He said that although some patients benefit from hormone therapy, it’s dangerous in the wrong patients—increasing insulin resistance, raising cholesterol, and increasing fat—likening it to the opposite of performance-enhancing drugs some athletes have taken. “You take away the muscles and give him fat,” Freedland said.
The study is published in the Journal of the American Medical Association.
Dr. Anthony D’Amico of Brigham and Women’s Hospital and the Dana-Farber Cancer Institute in Boston and colleagues studied 5,077 cases of men, average of about 70, diagnosed with localized or locally advanced prostate cancer between 1997 and 2006. All the men were treated with radiation therapy and 30 percent of them also took HT for an average of four months. Over a median follow-up of five years, 419 of the men died. Of those, 200 had no underlying cardiac conditions or risk factors, 176 had one coronary artery disease factor, such as high blood cholesterol, and 43 had suffered from heart failure or had a heart attack.
Analysis of the data showed that, when considering comorbidity groups separately, HT caused no increased risk of all-cause mortality in men with no co-existing conditions (9.6 percent vs. 6.7 percent) or those with a single coronary artery disease risk factor (10.7 percent vs. 7.0 percent). However, for those with a history of serious heart problems, HT was associated with nearly twice the risk of all-cause mortality (26.3 percent vs. 11.2 percent). “Our results should heighten awareness about the potential for harm with hormonal therapy for men with pre-existing heart disease,” said study author Dr. Akash Nanda of the Harvard Radiation Oncology Program in Boston. “The risks need to be balanced with the benefits. For more advanced disease, the primary treatment is a combination of hormone therapy and radiation. So, for them, it becomes a little more tricky.”
Some experts agree that co-existing heart conditions should be taken into account when deciding which treatment best suits a patient. “I think this is going to make people even more conservative in their use of hormones than when researchers started to identify who benefited,” said Dr. Eric M. Horwitz, acting chairman of the radiation oncology department at Fox Chase Cancer Center in Philadelphia. “We had always thought that there might be cardiac problems with long-term use of hormones, but this shows that even a short course can be harmful.”
For other experts, the findings weren’t unexpected. “For those who’ve been following the field, this is not surprising at all,” said Dr. Stephen Freedland, a Duke University prostate cancer specialist. He said that although some patients benefit from hormone therapy, it’s dangerous in the wrong patients—increasing insulin resistance, raising cholesterol, and increasing fat—likening it to the opposite of performance-enhancing drugs some athletes have taken. “You take away the muscles and give him fat,” Freedland said.
The study is published in the Journal of the American Medical Association.
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