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Risks of Hormone Therapy for Prostate Cancer

Study Shows Prostate Cancer Treatment May Be Risky for Patients Who Also Have Heart Disease
By
WebMD Health News
Reviewed by Louise Chang, MD

Aug. 25, 2009 - Prostate cancer patients with established heart disease have an increased risk of dying when they receive hormone therapy prior to radiation, a new study suggests.

Patients with a history of heart attack or congestive heart failure related to coronary artery disease who were treated with hormone therapy prior to radiation had twice the risk of death during the study as patients with the same heart history who did not have hormone therapy.

The study appears in the Aug. 26 issue of TheJournal of the American Medical Association. 

Hormone therapy, known medically as androgen deprivation therapy, can be given to shrink tumors and slow tumor growth before radiation treatment. The approach has been shown to improve survival in men with advanced or poor-prognosis prostate cancer.

But in several recent studies, this survival benefit did not exist in patients with other medical conditions such as diabetes, high cholesterol, and high blood pressure.

In an effort to better understand the impact of hormone therapy on survival in prostate cancer patients with these risk factors or a history of heart disease, researchers followed more than 5,000 patients for up to a decade.

All the study participants were treated at the same Chicago prostate cancer center with brachytherapy, which involves the implantation of radioactive seeds within the tumor to allow the delivery of higher and more targeted doses of radiation.

Some of the men in the study received four months of hormone therapy prior to radiation treatment and others had radiation without prior hormone therapy.

Just over 400 of the men died during follow-up and about half of those men had no other medical conditions. The rest had at least one risk factor for heart disease or established coronary artery disease leading to congestive heart failure or a previous heart attack.

Hormone Therapy and Heart Disease

Hormone therapy had no significant impact on death rates in men who had no other known illnesses or who had a single risk factor (diabetes, high blood pressure, or high cholesterol) for heart disease. Smoking history and family history of heart disease were not evaluated in this study.

But over an average follow-up of five years, men with a history of coronary-artery-disease-related congestive heart failure or heart attack were twice as likely to die if they had been treated with hormone therapy.

"Our results would suggest that hormonal therapy should not be used in these men or that their underlying heart disease should be addressed before they are considered for hormonal therapy," lead author Akash Nanda, MD, PhD, of Harvard University's Brigham and Women's Hospital, Dana-Farber Cancer Institute, tells WebMD.

Nanda was quick to point out that just 5% of the patients in the study -- 256 men in all -- had established heart disease, suggesting that the treatment may still offer a survival advantage to most men with poor-prognosis prostate cancer who are eligible for it.

But American Cancer Society deputy chief medical officer Len Lichtenfeld, MD, tells WebMD that questions remain about the risks vs. benefits of hormone therapy prior to radiation in men with risk factors for heart disease, such as poorly controlled diabetes, high cholesterol, and high blood pressure.

"It would be helpful to have additional studies that address this issue in men with one or more risk factors for heart disease," he says.

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