Navigation Links
Prostate Hormone Therapy May Up Heart Risks
Date:12/7/2009

Experts urge more awareness that long-term use has consequences

MONDAY, Dec. 7 (HealthDay News) -- Diabetes, heart attacks and other cardiovascular problems appear to be more common in men with prostate cancer who are treated with androgen deprivation therapy, which reduces or eliminates the male sex hormones that can promote cancer growth, a new study has found.

The finding indicates that androgen therapy is overused because its benefits have not been shown to outweigh its dangers in many cases, said Dr. Nancy L. Keating, associate professor of medicine and public health at Harvard Medical School and lead author of a report on the study published online Dec. 7 in the Journal of the National Cancer Institute.

"There are areas where hormone deprivation therapy has been shown to have a clear benefit," Keating said. "We're not suggesting that men who need hormone deprivation therapy should not have it. But lots of men get the therapy where it has not been shown to have a benefit."

One example is so-called PSA-recurrent cancer. Hormone deprivation therapy is started, Keating said, when levels of cancer-associated prostate-specific antigen (PSA) increase after surgery or radiation therapy, but there are no other indicators of danger.

"There has never been a trial showing an overall benefit in such cases," she said. "When you can have potentially serious adverse effects, you want to show caution."

Similarly, Keating said, no trial has shown an overall benefit for androgen deprivation therapy in cases where "watchful waiting" is chosen rather than radiation therapy or surgery for prostate cancer, Keating said.

"One third of men over 65 who don't have surgery or radiation get this therapy," she said. "Yet its effects have never been studied in a controlled trial."

Previous studies have shown potential dangers related to androgen deprivation therapy in older men, Keating said. The study she led looked at its effects on about 37,000 men treated for prostate cancer at Veterans Affairs hospitals.

Surgical removal of the testes was associated with a 40 percent increased risk for heart disease and a more than doubled risk for heart attack. Use of multiple hormone-blocking agents was associated with a 27 percent increased risk for heart disease.

The greatest risk was found for drugs that target gonadotropin-releasing hormone: 159.4 cases of diabetes per 1,000 person-years, compared with 87.5 for men who did not have androgen deprivation therapy, as well as a 35 percent increased risk for sudden cardiac death, a comparable increase in heart attack risk and a 22 percent increased risk for stroke.

Observational studies, which include all people with a condition, can never conclusively prove cause and effect, Keating acknowledged, because "the thing we can't account for is whether people who are on a treatment are different from those who aren't." But detailed evidence about the potential dangers of androgen deprivation therapy has not emerged from the more rigorous controlled trials that have been done "because they have looked only at cardiovascular deaths, and most patients who have heart attacks do not die of those heart attacks," she said.

Dr. Peter Albertsen, a professor and chief of urology at the University of Connecticut Health Center, said that "the point of this paper is to help physicians understand that long-term use of this therapy carries consequences." Albertsen wrote an accompanying editorial in the journal.

Anti-hormone therapy was developed to treat the pain and other problems of advanced prostate cancer, Albertsen said, and so it was generally used for only three to five years.

"Now, many more men are being started on androgen deprivation therapy long before there are any symptoms of prostate cancer so they may be on it for up to 15 years," he said. "We are beginning to realize that there can be significant problems in terms of cardiovascular risk. So the lesson is that if you start the therapy early, you should be sure that there is increased survival because there is a downside."

Dr. Eric A. Klein, chairman of the Cleveland Clinic Glickman Urological and Kidney Institute, said that the study "is confirmatory of a lot of other, smaller studies.

"There is a growing realization that we cannot use androgen deprivation therapy in a haphazard fashion," Klein said. "It does save lives or delay progression for men with metastatic prostate cancer so the trade-offs there are reasonable. But in many other cases, the downside probably exceeds the benefit."

More information

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



SOURCES: Nancy L. Keating, M.D., M.P.H., associate professor, medicine and health care policy, Harvard Medical School, Boston; Peter Albertsen, M.D., professor and chief, division of urology, University of Connecticut Health Center, Farmington, Conn.; Eric A. Klein, M.D., chairman, Urological and Kidney Institute, Cleveland Clinic, Cleveland; Dec. 7, 2009, Journal of the National Cancer Institute, online


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Hormonal Drugs Cool Hot Flashes From Prostate Cancer Therapy
2. PSA value at 2 years post-treatment can predict long-term survival in prostate cancer patients
3. Tulane Cancer Center to begin novel clinical trial for late-stage prostate cancer drug
4. Routine Evaluation of Prostate Size Not as Effective in Cancer Screening, Mayo Study Finds
5. Routine evaluation of prostate size not as effective in cancer screening, Mayo study finds
6. New finding suggests prostate biopsy is not always necessary
7. Does race, income predict prostate cancer outcome?
8. Chemo-radiation before prostate removal may prevent cancer recurrence
9. Blood vessels might predict prostate cancer behavior
10. Short-Term Hormone Therapy Added to Radiation Increases Survival for Medium-Risk, But Not Low-Risk, Prostate Cancer Patients
11. Adding Proton Therapy Boost to X-Ray Radiation Therapy Reduces Prostate Cancer Recurrences
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:2/12/2016)... ... February 12, 2016 , ... J Thomas & ... continuing it’s commitment to act as Agents of Change in the community, announces ... area homeless families to fulfill immediate needs and help them move into permanent ...
(Date:2/12/2016)... ... February 12, 2016 , ... Nearly every health website and ... These articles generally list between five and 15 foods that should be consumed ... one of these lists and believes that nutritious eye healthy foods are extremely ...
(Date:2/12/2016)... ... February 12, 2016 , ... Homeowners now have a ... CertainTeed, North America’s leading brand of building products, has improved upon its industry-best ... the mobile version of the ColorView® Exterior Style and Color Selector. Created expressly ...
(Date:2/12/2016)... (PRWEB) , ... February 12, 2016 , ... A lot ... past 35 years. A president has access to health and wellness resources most Americans ... free world, no single individual has a schedule as frenetic as the U.S. President. ...
(Date:2/12/2016)... ... , ... The Central Coast Autism Spectrum Center (CCASC) invites teens ages 11-18 to its annual ... for teens with and without special needs to gather in a safe and supportive environment. ... dance will take place on Saturday, Feb. 13 from 7 to 9:30 p.m. at Elks ...
Breaking Medicine News(10 mins):
(Date:2/12/2016)... Calif. , Feb. 12, 2016  Sequent Medical, ... in a study to evaluate the safety and effectiveness ... the treatment of ruptured intracranial aneurysms.  Prof Laurent ... Hospital, in Paris, France and ... patient. France and Germany.  ...
(Date:2/12/2016)... 2016  OMS Supply, a large provider of oral ... today the recent launching of their new company website. ... features that enhance the user experience and enable practitioners ... --> --> Despite the ... that started in early 2016, they have already made ...
(Date:2/11/2016)... - Cardiac Marker Diagnostic ... and Cancer Therapy. - European Point of Care ... - Key Diagnostic Testing Markets. - Molecular ... Genetic Testing. - Molecular Diagnostics in Infectious Disease ... Diagnostic Products World Markets. - Point of Care ...
Breaking Medicine Technology: