Prostate Cancer Treatment Can Be Risky
Hormone Treatment May Have Adverse Effects for Some Patients
In another study, Dutch researchers showed that men who delayed hormone
therapy were no more likely to die than those who started treatment
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
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
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
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.