Hormone therapy for prostate cancer puts heart at risk

Nancy Ferrari

Senior editor, Harvard Health

Physicians often prescribe androgen deprivation therapy, commonly called hormone therapy, to treat prostate cancer. The drugs, which have been given prior to surgery or in conjunction with radiation therapy, can shrink prostate tumors or slow their growth. But a recent study by researchers in Boston found a potential downside to hormone therapy: an increased risk of death from cardiovascular disease, especially among patients who have prostate surgery.

The researchers followed 4,892 patients with localized prostate cancer treated with either radical prostatectomy, radiation therapy, or cryotherapy, 1,015 of whom also received hormone therapy. (Cryotherapy destroys cancerous tissue by freezing it.) They found that men who had surgery and received hormones for an average of four months were 2.6 times more likely to die from cardiovascular disease than men who did not take hormones. Patients treated with radiation therapy or cryotherapy and hormones also had a higher incidence of death from cardiovascular disease than those who didn’t take hormones, but the difference was not statistically significant.

Although the exact connection between hormone therapy and death from cardiovascular disease remains unclear, the researchers noted that their findings indicated that patients should undergo a careful cardiovascular evaluation before starting hormone therapy.

SOURCE: Tsai HK, D’Amico AV, Sadetsky N, et al. Androgen deprivation therapy for localized prostate cancer and the risk of cardiovascular mortality. Journal of the National Cancer Institute 2007;99:1516–24. PMID: 17925537.

Originally published Jan. 1, 2008; last reviewed March 22, 2011.

Comments:

  1. Edson

    It depends on what mruease you’re using to define better , but the answer is probably No, by most mrueases. A much higher percentage of men in the U.S. than in the U.K. undergo screening, biopsy, and treatment. That can good OR bad, depending on how you look at it: A much higher percentage of men in the U.S. undergo *unnecessary* screening, biopsy, and treatment than in the U.K., but a small percentage more American men have their lives prolonged because of it. (Most do not. Prostate cancer generally has such late onset, and is so slow-growing, that for every men who survives other diseases long enough to die _of_ it, six men will die _with_ it, but of unrelated causes.)The average man diagnosed with prostate cancer in the U.S. has more years of life ahead of him than the average man diagnosed with prostate cancer in the U.K. But the comparison is not very worthwhile, because American men are, on the average screened earlier and diagnosed more liberally. Many men initially diagnosed with prostate cancer in the U.S. wouldn’t even be considered ill in the U.K. (Since these tend to be the men who will die of something else long before they die of prostate cancer, the diagnosis is technically accurate, but can be very misleading.) Prostate cancer is MUCH more expensive in the U.S. than in the U.K., by at least a factor of two and probably more like five or six. From the standpoint of society at large, that means treatment in the U.K. is much more cost-effective. On the other hand, it means that almost no men in the U.K. have their final days prolonged by drugs costing $5,000 a month, but some Americans do.Prostate cancer treatment is MUCH fairer in the U.K. than in the U.S. Any citizen of the U.K., no matter how poor, receives quite good medical care. In the U.S., a very few citizens receive much better medical care; most receive about the same; but a very substantial minority (40 to 80 million Americans) receive far worse care.

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