Hormone Therapy May Up Heart-Related Deaths in Some Prostate Cancer Patients

But the overall risk is small, researchers say

Wednesday, October 29, 2014

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WEDNESDAY, Oct. 29, 2014 (HealthDay News) -- Giving hormone therapy to men with prostate cancer who also have certain heart problems may increase their odds of dying from a heart-related cause, a new study suggests.

The therapy in question is called androgen deprivation therapy (ADT). It's used in prostate cancer to reduce levels of male hormones to prevent the growth of cancer cells, according to the study. And, in the current research, this hormone therapy was linked to triple the risk of heart-related death in men with heart failure or in those who had a previous heart attack, researchers found.

"ADT is a mainstay of prostate cancer therapy, but may not be the best option for all men," said lead researcher, David Ziehr, a medical student at Harvard Medical School in Boston.

Among men with heart failure or a past heart attack, ADT was associated with a 5 percent absolute increased risk of death from heart disease in five years, Ziehr said.

"The greatest cause of death among men with prostate cancer is heart disease, and patients and doctors must ensure that treatments and lifestyle choices harmonize to improve men's overall health," he said.

However, there is evidence that many men with prostate cancer are helped by hormone therapy. "When prescribing ADT for prostate cancer, physicians should take their patients' heart health into consideration," Ziehr said.

It's also important to note that while the study found a link between ADT and heart-related deaths in certain patients, the current study wasn't designed to prove that hormone therapy was the direct cause of the increased deaths.

For the study, Ziehr and colleagues collected data on more than 5,000 men treated for prostate cancer between 1997 and 2006. Among these men, 30 percent were treated with hormone therapy, according to the study.

Over an average follow-up of nearly five years, Ziehr's team found that men treated with hormone therapy who had heart failure or who had a previous heart attack were more likely to die from a heart-related cause than similar men not given ADT (7 percent versus 2 percent).

Ziehr said that based on these findings, giving hormone therapy to 20 men with heart failure or a history of heart attack could result in one heart-related death.

The researchers, however, did not find any significant link between ADT and heart-related deaths among men who didn't have heart disease or in men with diabetes, high blood pressure or high cholesterol.

The report was published online Oct. 29 in the journal BJU International.

Dr. Gregg Fonarow, a professor of cardiology at the David Geffen School of Medicine at the University of California, Los Angeles, said that overall, the benefits of hormone therapy appear to outweigh its risks.

"While some studies have suggested that ADT may be associated with an increase in risk for heart-related problems, an analysis of randomized clinical trials found no evidence of excess cardiac deaths," he said.

This new study also found no excess risk associated with ADT in the majority of patients studied, with the exception of a small subgroup with pre-existing heart failure or prior heart attack, Fonarow said. "However, these findings were of borderline statistical significance," he said.

"While the balance of data are reassuring with benefits outweighing potential risks, further studies are needed to determine if any specific group of patients are at increased risk with the use of ADT," Fonarow said.

SOURCES: David Ziehr, medical student, Harvard Medical School, Boston; Gregg Fonarow, M.D., professor, cardiology, David Geffen School of Medicine, University of California, Los Angeles; Oct. 29, 2014 BJU International, online

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