Heart Risk From Prostate Cancer Hormone Therapy
Androgen-Blocking Drugs May Carry Heart Risk, Doctor Groups Warn
Feb. 1, 2010 - Androgen-blocking hormone therapy for prostate cancer may
raise the risk of heart disease, warns an expert panel representing heart,
cancer, and urology organizations.
The warning means that a prostate cancer patient receiving hormone therapy
-- sometimes called chemical castration, although doctors prefer the term
androgen-deprivation therapy or ADT -- should keep close tabs on his heart
health. He does not need to see a heart specialist unless problems arise.
Several studies over the past few years have suggested an increase in heart
disease among men receiving hormone therapy for prostate cancer. Not all
studies show such a risk.
That led a panel of experts to review the data for the American Heart
Association, the American Cancer Society, and the American Urological
Their conclusion: The jury is still out, but there's enough concern to
advise men undergoing ADT to keep their cholesterol, blood sugar, and blood
pressure levels low. Those with existing heart disease should be on low-dose
aspirin if they can tolerate it. If they smoke, they should quit.
ADT drugs have the same effect as physical castration by shutting down
production of male sex hormones or androgens. Androgens make prostate cells
grow. ADT drugs that shut down these hormones are commonly used in the
treatment of prostate cancer:
- ADT is the mainstay of treatment for metastatic prostate cancer.
- ADT combined with external-beam radiation is standard treatment for men
with high-risk prostate cancer.
- Some men planning to undergo prostate cancer surgery or brachytherapy
(implantation of radioactive beads) may take ADT to reduce the size of their
- Men with rising PSA levels after prostatectomy or radiation therapy often
There are two types of ADT. The gonadotropin-releasing hormone (GnRH)
agonists Lupron, Zoladex, and Trelstar are most commonly used. Anti-androgens
such as Eulexin and Casodex are often combined with GnRH agonists.
Should prostate cancer patients with existing heart disease receive ADT?
That's for patients and their doctors to decide based on an evaluation of the
risks and benefits, the expert panel says.
The panel's advisory appears in the Feb. 16 issue of the American Heart
Association journal Circulation.