"A man has had radical prostatectomy [cancer surgery] and PSA starts rising again," Brawley said. "There has been a debate in the medical profession: Should we start hormonal therapy or just watch it go up and act only if we see the cancer spreading?"
More research is needed to determine the proper course of action in these and other cases where the course of the disease is not clear, the new advisory said.
Meanwhile, "the American Cancer Society is advising that physicians be aware that all hormone therapies for prostate cancer can have an increased risk of cardiovascular disease and diabetes and death," Brawley said. "They can be useful in treatment but should be used with caution."
A need for caution was also emphasized by Dr. Arthur Sagalowsky, a professor of urology and chief of urologic oncology at the University of Texas Southwestern Medical Center in Dallas and one of two urologists representing the American Urological Association on the panel that produced the advisory.
"One needs to be very careful in not overdrawing conclusions beyond what the panel has done," Sagalowsky said.
The risk for cardiac problems should be one of many issues discussed in the treatment of prostate cancer, he said. "It adds to the body of information that I present to patients with prostate cancer when they decide whether or if to begin androgen-deprivation therapy," he said. "How one decides will depend on the circumstances of the patient's prostate cancer, and this individual side effect is one of the issues that enter into the discussion."
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