Are you on a hormone blockade (ADT) and taking a baby aspirin to protect your heart? You might be putting your life at risk.
A recent small study with lead author Dr. Anthony V. D’Amico, chief of the division of genitourinary radiation oncology at Brigham & Women’s Hospital and the Dana-Farber Cancer Institute, found that men undergoing a hormone blockade (ADT) and taking a baby aspirin each day have a statistically higher chance of dying.
The study synopsis, which appeared in a letter published in the Dec. 27, 2007 issue of the New England Journal of Medicine, concluded that a baby aspirin when taken with ADT could interact with the blockade and elevate liver functions to a dangerous level. When this happens the blockade must be stopped, putting you at risk for continued prostate cancer progression and death.
These results were gleaned from a small study of 206 men with localized prostate cancers who were already enrolled in a trial to compare radiation therapy alone with radiation therapy plus hormone therapy. In the study the hormone therapy included six months of ADT using flutamide.
The Flutamide had a tendency to elevate levels on liver-function tests, which meant that the ADT had to be stopped, at least temporarily, D’Amico explained. Men who didn’t complete six months of hormone therapy were 3.5 times more likely to die from prostate cancer compared to men who got the full course of hormone therapy.
“An explanation for this interaction comes from previous animal studies,” D’Amico said. “For rabbits that take aspirin while undergoing hormone therapy, that aspirin is magnified 100-fold in terms of how much gets into the blood. That makes it a toxic dose of aspirin,” he explained.
According to Dr. D’Amico “If a man is taking baby aspirin just to prevent heart disease, we would ask the oncologist to ask the primary-care physician if he could come off the baby aspirin for the months while he’s getting cancer therapy. If the aspirin is just for prevention, this is probably the simplest thing to do.” “But if the patient is on aspirin because he absolutely needs it, then they’d have to treat the prostate cancer without hormone therapy. It really comes down to a trade-off: How much do they need the aspirin versus how much do they need hormonal therapy, and there are alternative treatments for prostate cancer.”
Your bottom line is if you are on ADT and taking a baby aspirin speak with your oncologist, primary care physician and cardiologist. Decide with them if you should continue or stop the blockade or the baby aspirin.
Joel T Nowak MA, MSW
After I posted this Charles (Chuck) Maack on the ProstateCancer Listserv pointed out that we can not automatically assume that we will see similar results from the other anti-androgen drugs currently used today in ADT. This is very true, so thank you Chuck. However, I believe that these results should throw up a cautionary red flag until the research community is able to look at these other drugs to evaluate the effects they may have when combined with aspirin.