I have always assumed that treating my prostate cancer with a hormone blockade increases my risk of having a cardiovascular problem that increases my chance of death. Taking any drug is always a trade off, one benefit against the potential harms. It is a perfect risk-reward situation.

However, there is some new research that makes the decision to move ahead with a hormone blockade (ADT) a much more confusing decision. According to this research, treating prostate cancer patients with ADT does not appear to increase the risk of death from cardiovascular disease, this finding is in direct contratiction to prior research findings. The study was conducted at the Massachusetts General Hospital (MGH). However, in a report written in 2006 the same study team found that treatment with ADT does increased the risk of diabetes and heart disease, the current study is the first to examine whether treatment actually increased heart-disease-related deaths.

In their Journal of Clinical Oncology report, which has been released online, the researchers note that GnRH agonist treatment has a number of adverse side effects, which should be kept in mind when determining treatment strategies. Since ADT has over recent years become very common, even with men believed to have organ confined disease doctors must remember the fact there are many potential negative side effects. It is estimated that one-third of the two million prostate cancer survivors in the U.S. are currently receiving this therapy, making understanding the potential adverse effects of treatment particularly important.

Additionally, it must be remembered that the absence of an increase in cardiovascular mortality does not exclude the possibility that GnRH agonists increase non-cancer deaths through other mechanisms. We must remember that besides the increased risk for diabetes identified in the 2006 study, we know ADT can raise the risk of fractures and anemia – both of which can reduce survival – and can have adverse effects on weight gain, cholesterol levels, mood and sexual function.

Co-authors of the Journal of Clinical Oncology paper are William Shipley, MD, MGH Cancer Center; Kyounghwa Bae, PhD, Radiation Therapy Oncology Group, Philadelphia; Gerald Hanks, MD, Fox Chase Cancer Center, Philadelphia; Miljenko Pilepich, MD, University of California at Los Angeles Medical School; and Howard Sandler, MD, Cedars-Sinai Medical Center, Los Angeles. The study was supported by grants from the National Institutes of Health and the Prostate Cancer Foundation.

Just to add to our confusion.

Joel T Nowak MA, MSW