Androgen-deprivation Therapy Increases Risk of Death in Men with Heart Disease

Posted on September 1st, 2009 by

Among men with prostate cancer and a history of heart attack or congestive heart failure, receipt of androgen-deprivation therapy prior to radiation therapy increased the risk of death. These results were published in the Journal of the American Medical Association.

Standard therapy for early prostate cancer may include surgery, radiation therapy, hormone therapy (androgen-deprivation therapy), or watchful waiting (no treatment until disease progression). Optimal treatment for early prostate cancer is still under debate. Several factors that may be considered when selecting treatment for early prostate cancer include age, aggressiveness of the cancer, extent of spread, other existing medical conditions, and side effects of therapy.

Androgen deprivation therapy (ADT) can slow prostate cancer growth by reducing levels of testosterone. Some studies have suggested that the addition of ADT to radiation therapy improves outcomes among men with poor-risk prostate cancer, but the benefits and risks of ADT may vary by the underlying health of the patient.

To explore whether the risks of ADT are different for men with and without heart disease, researchers conducted a study among 5,077 men with localized or locally advanced prostate cancer (prostate cancer that has not spread to distant sites in the body). Some men were treated with radiation therapy alone, and others were treated with ADT before radiation therapy.

  • Among men with no history of heart attack or congestive heart failure, receipt of ADT did not significantly influence the risk of death.
  • Among men with a history of heart attack or congestive heart failure due to coronary artery disease, ADT almost doubled the risk of death.

These results suggest that the addition of ADT to radiation therapy increases the risk of death among men with a history of heart attack or congestive heart failure due to coronary artery disease.

Reference: Nanda A, Chen M-H, Braccioforte M, Moran JB, D’Amico AV. Hormonal therapy use for prostate cancer and mortality in men with coronary artery disease-induced congestive heart failure or myocardial infarction. Journal of the American Medical Association. 2009;302:866-973.

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