Harvard Men's Health Watch

Some prostate cancer treatments increase heart attack risk

In the journals

If you have suffered a heart attack and plan to undergo prostate cancer treatment, you may want to weigh the risks and benefits of androgen deprivation therapy (ADT). ADT decreases the amount of androgens in the body, which prostate cancer needs to grow and survive. It is also often used along with radiation therapy, and the combination has been shown to prolong survival in men with unfavorable-risk prostate cancer—defined as cancer with two or more high-risk factors, like a PSA level between 10 and 40 ng/mL, a Gleason score of 7 or higher, or biopsies with 50% or higher cancerous cells.

But a study in The Journal of the American Medical Association suggests that men who had a prior heart attack can increase their risk of a fatal one if they undergo both radiation therapy and ADT. Researchers compared overall survival and death from prostate cancer, fatal heart attack, and other causes in a group of 206 men with unfavorable-risk prostate cancer. The men received either radiation alone, or radiation and six months of ADT. The researchers also categorized the men into subgroups based on other health conditions, including heart disease.

After a 16-year follow-up, researchers found that among the subgroup who had a previous heart attack, treatment with both radiation and ADT reduced their 15-year survival rate to 8%, compared with 20% for those who were treated only with radiation. These findings suggest doctors should rethink how to manage prostate cancer in men with known heart disease, says lead researcher Dr. Anthony D'Amico of the Harvard-affiliated Brigham and Women's Hospital.