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 Association.
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 prostate.
- Men with rising PSA levels after prostatectomy or radiation therapy often take ADT.
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.