It was reported in the October 17th issue of the Journal of the National Cancer Institute by lead author Dr. Henry K. Tsai, from the Harvard Radiation Oncology Program in Boston, that the use of androgen deprivation therapy (ADT) appears to increase the risk of death from cardiovascular disease among men who undergo radical prostatectomy for localized prostate cancer, Dr. Tsai assessed the risks of androgen deprivation therapy in 3,262 men who underwent radical prostatectomy and 1,630 treated with radiotherapy or other localized treatment, with an average follow-up period was 3.8 years.
Shockingly, the researchers found that ADT increased the risk of death from cardiovascular disease by 2.6-fold!
“Treatment with androgen deprivation therapy can be beneficial in patients with unfavorable prostate cancer. However, clinicians should carefully weigh the potential risks and benefits of androgen deprivation therapy, and consider a cardiovascular evaluation for their patients prior to initiating androgen deprivation therapy,” Tsai advised.
He did go on to recommend that additional studies need to be done to confirm the associations among ADT, cardiovascular disease, and mortality. “Methods of reducing the potentially negative side effects of androgen deprivation therapy should be explored,” he added.
Those of us who are on ADT or looking to begin it should be evaluated by a cardiologist so that the risks and potential rewards of ADT can be evaluated.
Joel T. Nowak MA, MSW
Joel,
It is important to note that this was the case for those 65 or older treated with surgery and not other treatments.
The authors concluded:
“ADT use was associated with a higher cumulative incidence of death from cardiovascular causes, but the difference did not reach statistical significance. Conclusions The use of ADT appears to be associated with an increased risk of death from cardiovascular causes in patients undergoing radical prostatectomy for localized prostate cancer.”
The word “appears” is significant because this was the case for surgical patients only…
RalphV
Ralph,
Here is an anaylsis of 1,372 men who received radiation. For those who also went on ADT there was a significant increase in risk for for a heart attack
2.5 years earlier then they might otherwise have suffered one.
Clearly, ADT does change the cornary landscape.
Joel
“Prostate Cancer Therapy May Worsen Heart Threat
Men at high cardiac risk should remedy those problems before tumor
treatment starts, researchers say.
by Thomas H. Maugh II | Los Angeles Times | 06.09.2007
Standard treatment for prostate cancer — shutting off the body’s
production of androgen hormones — can shorten by 2 1/2 years the
lives of men who are at high risk of developing heart disease, Boston
researchers reported Friday.
The drugs used to suppress the hormones produce anemia, weight gain
and insulin resistance, a constellation of factors known as metabolic
syndrome.
These effects can sharply increase the risk of a fatal heart attack,
especially in men already at high risk, Dr. Anthony D’Amico of Brigham
and Women’s Hospital in Boston reported in the Journal of Clinical
Oncology.
Because the drugs can slow or halt the progression of a prostate
tumor, researchers are not advocating that physicians stop using them.
Instead, they say, prostate cancer patients should be screened for
cardiovascular risk, and those with risk factors should be
aggressively treated for their potential heart disease before cancer
therapy begins.
The medical field has come to realize “in the last year or two that
hormone therapy has cardiovascular side effects and we need to pay
attention to it,” said Dr. Eric Klein of the Cleveland Clinic, who was
not involved in the study. “I’ve already changed my practice.”
The risk factors, he added, “are correctable and need to be corrected
before treatment or concurrently.”
The new study grew from a clinical trial of androgen suppression
conducted by D’Amico. “I observed that there were a few men receiving
treatment who died quickly of a heart attack,” he said.
The 206-man sample in his study was not large enough, so he combined
his results with data from studies in Canada, Australia and New
Zealand. That brought the total number of men to 1,372, about half of
whom received both radiation and hormone suppression therapy and half
of whom received only radiation.
During the five years the men were tracked, 51 had fatal heart
attacks, half of whom had had hormone suppression therapy. But the
older men who received the therapy suffered their heart attacks about
2 1/2 years earlier, on average, than those who had not received it.
The heart attacks “occurred within the first six months to two years
after treatment,” D’Amico said.
“There wasn’t an increased number of heart attacks, it is just that
they occurred sooner.”
The heart attacks affected about 2.5% of the men receiving treatment, he said.
The primary risk factors were diabetes and smoking. Obesity, high
cholesterol levels and high blood pressure were also predictive.
D’Amico said he had begun referring high-risk cardiac patients for
therapy, which includes aspirin, cholesterol-lowering statins,
angioplasty and, for some, open-heart surgery.
“Hormonal therapy in men who need it is lifesaving,” he said. But the
cure rate “could be even higher if we screen the appropriate men for
coronary risk factors.”
Experts noted that oncologists had previously used estrogen in
prostate cancer patients to suppress androgen hormones, but that use
was abandoned in the late 1980s when clinical trials showed an
increase in the risk of heart attacks.”
Copyright 2007 Los Angeles Times
This 58 year old male had quadruple coronary by-pass surgery in December 1997. I was diagnosed with prostate cancer in April 2004. July 2004 failed surgery – lymph nodes positively metasticized, prostate not removed. July 2004 begin Zoladex 3 month injections and Casodex daily. May-Jun 2005 External Beam Radiation. Still currently on hormone therapy now over 3 years. Physical side effects from hormone therapy include weight gain 50-60 pounds, breast enlargement, foot pain and frequent hot flashes. Mental side effects include feelings of despair, depression, doom and gloom, lack of focus, short attention span, frequent mood swings, emotional displays, crying, anger, anxiety and feelings of isolation. I am still able to work and am self-employed. However, my business is currently experiencing a recession which is also compounded by my mental state described above. I have no medical insurance however I am being treated through the VA Healthcare system.
For my cardiac care I take Zocor, Metoprolol tartrate, Losartan, Hydrochlorothiazide, aspirin, niacin.
Add synthroid and pantoprazole, isn’t life grand?
I seek relief from the negative mental aspects of the hormone therapy. Otherwise I am active, play guitar and sing, work in the yard, paint, walk the dogs etc.
There is no sex life. Absolutely no desire whatsoever.
Blessing or curse??? At 58 years I am counting it as a blessing. It feels rather liberating but have not found many people who can relate.
Nor have I found too many people willing to discuss or who feel inclined to discuss prostate cancer.
This is my story. Just sharing if anyone has interest.
Robert,
Your story is very sad. People who don’t suffer from pc can not understand the many negative quality of life issues that the treatment often costs us.
Unfortunately, most people, including men, think that prostate cancer is no big deal, “it’s slow growing or it’s a disease of the very old.” As we know this just isn’t true. Even if pc is an older man’s disease (which it is not, why should our older citizens suffer.
You didn’t share any of your numbers,nor did you share why you have remained on ADT for such a long period of time. Current research (search the blog) indicates that there is no difference in morbidity rates for men on continuous vs. intermittent therapy.
I have found, along with many men I speak with, that going on a “drug holiday” can provide improvements in the quality of life. My only concern is that after three years on therapy you might not be able to recover. I would speak with my doctors about the pros and cons of going off therapy given your specific medical condition.
I also have found that joining a good support group helps to moderate the isolation. I do not know where you live, but check the Malecare web page at http://www.Malecare.com and see if there is a group near you. You should also check with your hospital, doctor or go to USTOO to find a support group.
Good luck.
Joel
Hi Joel,
Thank you for your kind words. My opinion, like yours, is that the great majority of people have no clue regarding the mental and physical anguish associated with the treatment of prostate cancer.
I have spoken with my doctors at the VA and they believe that intermittent therapy is not the way to go. Since hormone therapy began over 3 years ago, my PSA has been 0.005 or below. They believe that this along with my 40 radiation treatments have successfully kept the advance at bay. They do not believe change is warranted.
Currently I feel that the treatment is worse than the disease however I fear that day when advancement of the disease is noticed. My opinion could and probably will change rapidly.
I organized the effort (my sphere of influence) and participated in the USTOO event “Sneaker’s at work” earlier this year. I was successful in raising money but did not feel awareness was realized. (Although some minor success achieved from a couple of men who did have their PSA checked.) I tried to contact USTOO chapter where I live but got no response. I will look into malecare.com website.
Many thanks,
Robert