Not a very big surprise but androgen-deprivation therapy (ADT) substantially increases the risk for cardiovascular and bone-related problems, as well as for diabetes, according to a review of the medical literature published online April 27 in the journal Cancer.

At the University of Texas Health Science Center in Houston, Lockwood G. Taylor wrote a review of the literature on adverse morbidity issues that are related to the use of ADT in prostate cancer. Initially, they reviewed 683 articles for data on cardiovascular and bone-related outcomes, with 14 articles meeting the inclusion criteria. In some cases, researchers pooled relevant data and calculated risk estimates.

They concluded that men receiving ADT had a 23 percent increase in risk of fracture (relative risk, 1.23) and a 17 percent increase in cardiovascular-related mortality (hazard ratio, 1.17) compared to prostate cancer patients who did not undergo ADT. Additionally, in two large studies ADT increased the risk of diabetes between 36 and 49 percent.

“Androgen-deprivation therapy was associated with an increased risk of skeletal fracture, incident diabetes, and cardiovascular-related mortality, although the absolute risk of these events was low. Preventive measures against these adverse effects and careful assessment of patient’s baseline health status should be considered,” the authors conclude.

I think that we all already knew these facts, but the gathering of data into one review only serves to reinforce the facts most of us knew. What I have not heard of was anyone asking if the benefits (the FDA requires survival time) out way these significant risks. Not only is there an increased risk of diabetes and fractures, but the potential of dieing from cardiovascular problems is significant and scary.

Joel T Nowak MA, MSW