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Public release date: 05 December 2007
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Prostate cancer therapy linked to increased risk of heart disease death
The use of androgen deprivation therapy to treat localized prostate cancer
is associated with an increased risk of death from heart disease, according
to a study published online October 9 in the Journal of the National Cancer
Institute.
Androgen deprivation therapy is frequently used to treat high-risk localized
prostate cancer. Studies have shown that androgen deprivation therapy, when
used with external beam radiation therapy, improves survival in patients
with advanced and localized prostate cancer. But the use of androgen
deprivation therapy can also lead to the development of metabolic syndrome,
which increases the risk of type II diabetes or coronary artery disease.
Henry Tsai, M.D., of Harvard Medical School in Boston and colleagues
investigated whether androgen deprivation therapy increases the risk of
death from heart disease in patients treated for localized prostate cancer.
They collected data on 3,262 patients treated by surgical removal of the
prostate and 1,630 patients treated with certain radiation therapies or
cryotherapy (in which the tumor tissue is frozen to kill the cells). Of
these patients, about 1,000 were also treated with androgen deprivation
therapy.
After a median follow-up of nearly 4 years, 131 patients died of heart
disease. Both androgen deprivation therapy and older age were associated
with an increased risk of death from heart disease. Among men 65 years and
older who had their prostates removed, the 5-year incidence of heart
disease-related death was 5.5 percent for those receiving androgen
deprivation, and 2 percent among those who did not. For men younger than 65
years, the rates were also increased, 3.6 percent and 1.2 percent
respectively. There was also an increased risk of death in men who received
androgen deprivation in addition to radiation or cryotherapy, but it was not
statistically significant.
"The results of this study and others support the view that use of [androgen
deprivation therapy] may contribute to death from cardiovascular causes and
underscore the importance of careful cardiovascular evaluation and
intervention before initiating [androgen deprivation therapy] in patients
with localized prostate cancer," the authors write.
In an accompanying editorial, Jerome Seidenfeld, Ph.D, of the Blue Cross and
Blue Shield Association in Chicago and colleagues explain that the design of
the study makes it difficult to conclude whether androgen deprivation
therapy caused the increase in deaths from heart disease. They point out
that it is unlikely that androgen deprivation therapy would have these
effects only in men whose prostates were removed but not those treated with
radiation and other methods.
"The article by Tsai [and colleagues] has raised an interesting hypothesis,
but patients and clinicians need better risk estimates for cardiovascular
death associated with [androgen deprivation therapy] use that are based on
randomized trials rather than retrospective analysis," the editorialists
write.
Article: Tsai HK, D'Amico AV, Sadetsky N, Chen M-H, Carroll PR. Androgen
Deprivation Therapy for Localized Prostate Cancer and the Risk of
Cardiovascular Mortality. J Natl Cancer Inst 2007; 99:1516-1524
Editorial: Seidenfeld J, Samson DJ, Albertsen PC. Competing Risks for
Patients With Localized Prostate Cancer. J Natl Cancer Inst 2007;
99:1498-1499
ScienceDaily. Retrieved December 4, 2007, from
http://www.sciencedaily.com/releases/2007/10/071009164154.htm
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