The standard of care and the facts are simple. Men who have aggressive prostate cancer and elect to have radiation therapy will benefit from six months of concurrent hormone therapy (ADT). However, based on recent findings by D’Amico etal, there seems to be a segment of men who will not benefit, but will have inferior results if ADT is added to their radiation therapy.
D’Amico found that men with prostate cancer who also have had a heart attack might fare better with radiation therapy alone rather than with radiation plus ADT.
He found that when the data was analyzed over an average of 17 years of follow-up, men with high-risk prostate cancer who also had a heart condition lived longer after radiation treatment than a similar group of men who had radiation and ADT. However, men who didn’t have a history of heart problems lived longer if they had both radiation therapy and ADT.
“There have been several trials looking at radiation with or without hormone therapy in high-risk prostate cancer, which found a survival benefit from combined treatment,” said lead researcher Dr. Anthony D’Amico, chief of radiation oncology at Brigham and Women’s Hospital in Boston.
However, whether hormone therapy causes an increase in death from heart problems has been controversial, he said. Several studies have not found a difference in survival.
D’Amico defined high-risk prostate cancer is cancer that is confined to the prostate but likely to spread to other parts of the body (likely to become advanced prostate cancer).
“We found that there was no survival benefit to adding hormones to men who had had a heart attack,” D’Amico said. “In fact, they died sooner.” He went on to add, “The main cause of death was a fatal heart attack.” “We know hormone therapy causes a variety of problems, including raised blood pressure and raised blood sugar,” D’Amico explained.
In his discussion D’Amico was careful to point out that since the study analyzed data from a completed trial, it doesn’t prove hormone therapy caused heart attacks. “It’s an association, it’s not proof.…but there is a good likelihood that it’s true,” he added.
Given his findings he strongly has recommended that men who have had a heart attack or other coronary problems and who need hormone therapy should get their cardiologist involved in the decision making and the monitoring.
Anthony V. D’Amico, Ming-Hui Chen, Andrew Renshaw, Marian Loffredo, Philip W. Kantoff. Long-term Follow-up of a Randomized Trial of Radiation With or Without Androgen Deprivation Therapy for Localized Prostate Cancer. JAMA, 2015; 314 (12): 1291 DOI: 10.1001/jama.2015.8577
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