Heart Risk From Prostate Therapy

Oct. 9, 2007 – Depriving the body of male sex hormones fights prostate cancer, but it boosts a man's risk of dying of heart disease.

Androgens -- male sex hormones -- make prostate cancers grow faster. Men with prostate cancer may opt to take drugs that block the effects of androgens, or they may remove the source of the hormones, the testicles, via an operation called an orchiectomy.

Because they deprive the tumor of androgens, these treatments are collectively known as androgen deprivation therapy. Androgen deprivation therapy may be offered before other treatments for prostate cancer, especially radiation therapy. It may also be offered after other treatments to prevent or treat recurrent cancer.

There's no doubt androgen deprivation therapy has a benefit. But recently, researchers have uncovered a new risk: heart disease. Studies show increased risk factors for heart disease in men undergoing androgen-deprivation therapy.

Does this mean an actual increase in risk of death from heart disease? Yes, find Henry Tsai, MD, and colleagues.

"We looked at a large population of men with prostate cancer treated with surgery, one or another form of radiation, or cryotherapy. Then we looked at men treated with the same things but also given a short course of androgen deprivation therapy," Tsai tells WebMD. "We found that the men who received androgen deprivation therapy, especially those with surgery as well, had an increased risk of death from cardiovascular disease."

The researchers analyzed their findings according to the patients' age and the primary treatment they received. Among the 3,262 patients who underwent prostate surgery, the 266 men who also received androgen deprivation therapy had a 2.6-fold higher risk of dying from heart disease.

Most of the deaths were in patients aged 65 and older.

"In patients 65 and older with surgery and androgen deprivation therapy, their five-year risk of cardiovascular death was 5.5%. For those who didn't have androgen deprivation therapy, their five-year risk was 2%."

Androgen Deprivation Risk, Androgen Deprivation Benefit

How big is the risk?

"It depends on how you present the information," Tsai says. "It looks like more than a twofold jump in risk, but it is only a 3% difference. It is a significant increase, but in absolute terms it is pretty small."

The study showed no significant risk for men who received androgen deprivation therapy along with other prostate cancer treatments. However, Tsai considers this to be a statistical fluke due to the relatively small number of study patients given treatments other than surgery.

That's also the opinion of Jerome Seidenfeld, PhD, associate director of the Blue Cross and Blue Shield Association's technology evaluation center in Chicago. Seidenfeld's editorial accompanies Tsai and colleagues' report in the Oct. 17 issue of the Journal of the National Cancer Institute.