Prostate Cancer Treatment Can Be Risky
Hormone Treatment May Have Adverse Effects for Some Patients
Delaying ADT continued...
They studied 234 men with prostate cancer that had spread to lymph nodes, but not to other organs. None of the men were given radiation. Instead, they were assigned to immediately start treatment with a hormonal drug called Zoladex or to get Zoladex only when they got worse. Zoladex works to interfere with the production of male hormones.
By 13 years later, men in both groups were equally likely to be alive.
Researcher Fritz H. Schroder, MD, PhD, of Erasmus Medical Center in Rotterdam, Netherlands, says delayed therapy offered men a better quality of life for an average of 18 months.
Bruce J. Roth, MD, head of the committee that chose the studies to be presented at the meeting and a medical oncologist at Vanderbilt-Ingram Cancer Center in Nashville, Tenn., says further study is needed.
But given the findings, he says he might hold off on ADT in men who aren't committed to the idea of earlier treatment.
ADT and Heart Risk
Harvard researchers found no evidence that men treated with radiation plus ADT were more likely to die of heart disease than patients treated with radiation alone.
Jason Efstathiou, MD, and colleagues studied about 950 men with advanced prostate cancer. That means the cancer has grown through the outer rim of the prostate and into nearby tissue.
They were given either radiation plus hormone therapy with Zoladex, or radiation alone.
Over a five-year period, 4.1% of men given Zoladex died of heart disease vs. 6.5% of men given radiation alone -- a difference so small it could have been due to chance.
However, men on hormone treatment were more likely to die of any cause, Efstathiou says. "The absence of an apparent increase in death due to heart disease does not exclude the possibility that hormone therapy increases the risk of noncancer death due to other mechanisms."
According to Klein, "All these studies are telling us the same thing. Hormone therapy carries risks and we should only use it in those patients most likely to benefit."
Men should talk to their doctors about the risk and benefits of ADT, he advises.
D'Amico adds that men who have risk factors for heart disease, such as smokers and people with diabetes, should undergo a cardiac evaluation before they start hormonal therapy to treat prostate cancer.