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Hormone Therapy for Early Prostate Cancer Not Always Best
Date:8/25/2009

Study finds treatment raises death risk in those who also have heart disease

TUESDAY, Aug. 25 (HealthDay News) -- Men who have been diagnosed with prostate cancer and who also have underlying heart disease may not benefit from treatment with hormones, new research suggests.

In fact, such hormone therapy may actually increase their odds of dying.

"For men who've had a prior heart attack or heart failure, use of hormone therapy for prostate cancer was associated with a shortened lifespan," said study author Dr. Akash Nanda, a radiation oncology resident with the Harvard Radiation Oncology Program at Brigham & Women's Hospital/Dana-Farber Cancer Institute in Boston. The report appears in the Aug. 26 issue of the Journal of the American Medical Association.

The findings essentially change the risk-benefit profile when deciding which treatment suits which patient, and could change practice fairly quickly, said Dr. Ronald D. Ennis, director of radiation oncology at St. Luke's-Roosevelt Hospital Center and associate director of Continuum Cancer Centers of New York in New York City.

Although more studies are needed, Ennis added, "many of us are concerned enough about this issue that, for a while, we might start to use this information in our decision-making, especially for people for whom hormone therapy is not indicated or needed."

"I think this is going to make people even more conservative in their use of hormones than when researchers started to identify who benefited," added Dr. Eric M. Horwitz, acting chairman of the radiation oncology department at Fox Chase Cancer Center in Philadelphia. "We had always thought that there might be cardiac problems with long-term use of hormones, but this shows that even a short course can be harmful."

Hormone therapy, when used with radiation therapy, can increase survival in more aggressive cases of prostate cancer. But this benefit tended to shrink in men who also suffered from other conditions.

Until now, however, experts have not known which other conditions were responsible for the jump in risk.

"There have already been a fair number of studies looking at this question, which have tended to suggest a problem with hormone therapy causing cardiac death but not consistently," Ennis said. "The thing this study has been able to do that others have not is to break people down by their risk for having cardiac disease."

Nanda and his colleagues looked at more than 5,000 men, average age about 70, with localized or locally advanced prostate cancer who were treated with radiation therapy alone or radiation therapy plus hormone therapy. Participants were followed for close to five years.

Hormone therapy was not linked with a higher risk of death from any cause in men who had no underlying cardiac conditions or only one risk factor for coronary artery disease.

But men who had congestive heart failure or who had suffered heart attacks as a result of coronary artery disease had almost double the risk of death, the researchers found.

Overall, however, only 5 percent of the initial 5,000 men studied experienced an increased death rate as a result of hormone therapy.

"Men with favorable risk [less aggressive] prostate cancer only receive hormone therapy to shrink their gland and make them eligible for brachytherapy [radioactive "seeds" are planted inside the malignant tissue] and, in that setting, if the patient has a history of heart attack or heart failure, we would recommend that they consider alternative treatment strategies such as external beam radiation alone or active surveillance [doctors follow the cancer without actually treating it at that time]," Nanda said.

"But for men who have more aggressive cancer, several clinical trials have shown that adding hormone therapy to radiation actually leads to an increase in survival and so, for this cohort of men, our results would suggest that if they do have preexisting heart disease that either hormone therapy not be used or that their underlying heart disease be initially addressed by their primary care physician and/or a cardiologist," Nanda added. "The risks need to be balanced with the benefits. For more advanced disease, the primary treatment is a combination of hormone therapy and radiation. So, for them, it becomes a little more tricky."

More information

The U.S. National Cancer Institute has more on prostate cancer.



SOURCES: Akash Nanda, M.D., Ph.D., radiation oncology resident, Harvard Radiation Oncology Program, Brigham & Women's Hospital/Dana-Farber Cancer Institute, Boston; Ronald D. Ennis, M.D., director, radiation oncology, St. Luke's-Roosevelt Hospital Center, and associate director, Continuum Cancer Centers of New York, New York City; Eric M. Horwitz, M.D., acting chairman, radiation oncology department, Fox Chase Cancer Center, Philadelphia; Aug. 26, 2009, Journal of the American Medical Association


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