A new study first published online in the October 29, 2014 issue of BJU International, has found that certain prostate cancer medications are linked with an increased risk of dying from heart-related causes in men with congestive heart failure or prior heart attacks. According to the authors, the findings will help doctors and patients weigh the benefits and risks of these drugs.
Androgen deprivation therapy or ADT, which is designed to reduces levels of male hormones in the body to prevent them from stimulating cancer cells, is a mainstay of treatment for prostate cancer. Despite its anticancer effects, ADT has also been associated with increased risk of diabetes as well as cardiovascular problems,including , coronary heart disease, heart attacks, and sudden cardiac death.
…androgen deprivation therapy can be a lifesaving drug for men with prostate cancer and significantly increase the cure rates when used with radiation for aggressive disease… however … there is the possibility that a small subgroup of men who have significant heart disease could experience increased cardiac death…
To thoroughly investigate this potential link, Paul Nguyen, MD, of the Dana-Farber/Brigham and Women’s Cancer Center in Boston, along with David Ziehr of Harvard Medical School and their colleagues, analyzed information on 5,077 men (median age, 69.5 years) with cT1c-T3N0M0 prostate cancer who were treated with brachytherapy with or without neoadjuvant ADT (median duration, four months) between 1997 and 2006. A total of thirty percent of these men received ADT, while the others did not.
The researchers found that after a median follow-up of 4.8 years, no association was detected between ADT and heart-related deaths in men with no cardiac risk factors (1.08% at five years for ADT versus 1.27% at five years for no ADT) or in men with diabetes, hypertension, or high cholesterol (2.09% vs 1.97%).
However, the researchers observed that androgen deprivation therapy was associated with a 3.3-times increased risk of heart-related deaths, in men with congestive heart failure or prior heart attacks. In this subgroup, heart-related deaths occurred in 7.01% of men receiving ADT versus 2.01% of men not receiving after five years. This suggests that administering the therapy to 20 men in this potentially vulnerable subgroup could result in one cardiac death.
Benefits – and risks
“While androgen deprivation therapy can be a lifesaving drug for men with prostate cancer and significantly increase the cure rates when used with radiation for aggressive disease, this study also raises the possibility that a small subgroup of men who have significant heart disease could experience increased cardiac death on ADT,” Nguyen noted.
Nguyen further said: “Because the study was retrospective, it must be carefully weighed against larger controlled trials that have demonstrated the benefits of ADT. I would still say that for men with significant heart problems, we should try to avoid ADT when it is not necessary—such as for men with low-risk disease or men receiving ADT only to shrink the prostate prior to radiation. However, for men with high-risk disease, in whom the prostate-cancer benefits of ADT likely outweigh any potential cardiac harms, ADT should be given even if they have heart problems, but the patient should be followed closely by a cardiologist to ensure that he is being carefully watched and optimized from a cardiac perspective.”
For more information:
Ziehr DR, Chen MH, Zhang D, Braccioforte MH, Moran BJ, Mahal BA, Hyatt AS, Basaria SS, et al. Association of androgen deprivation therapy with excess cardiac-specific mortality in men with prostate cancer. BJU International; Published Online: October 29, 2014 DOI: 10.1111/bju.12905 [Article][PubMed].
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