A new study links hormone therapy for prostate cancer with a higher risk of death in older men who’ve had serious heart problems.
The side effects of hormone therapy can be significant. They include impotence, bone loss, hot flashes, memory problems, fatigue and an increased risk for diabetes and heart disease.
In a study appearing in Wednesday’s Journal of the American Medical Association (JAMA), funded by Brigham and Women’s Hospital and the Dana-Farber Cancer Institute in Boston, researchers followed more than 5,000 men with localized prostate cancer (still confined in the prostate gland). Most of the sample in this study were in their 60s and 70s, and they were followed for an average of five years. Additionally, all had brachytherapy or seeds as their primary treatment. Thirty percent of them also took hormone therapy for an average of four months.
Five percent of the men in the study had a history of heart failure or heart attack and 43 of those men died. Among those with heart problems, the hormone treatment was linked with a 96 percent higher risk of death after adjusting for other risk factors.
In raw numbers, of the 95 men on hormone therapy who also had a history of serious heart problems, 25 died; and of the 161 men not on hormone therapy who also had a history of heart problems, 18 died.
“Our results should heighten awareness about the potential for harm with hormonal therapy for men with pre-existing heart disease,” said lead author Dr. Akash Nanda of the Harvard Radiation Oncology Program in Boston.
This study’s results are consistent with many prior studies that have found that sicker men don’t benefit from hormone therapy when it’s added to radiation. And hormone therapy used alone in older men has been linked to a heightened risk of death. Hormone therapy can be dangerous in the wrong patients as it can increase insulin resistance, increases fat and raise cholesterol.
This study did not look at men with advanced disease, but I believe that the results would be consistent. Since men with advanced disease will probably be sicker it is conceivable that the increase in heart problems will ultimately lead to increases of death in men with advanced prostate cancer. So be cautious starting hormone therapy, especially if you have any history of heart problems.
Joel T Nowak MA, MSW