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Prostate cancer medications linked with increased risk of death from pre-existing heart problems

Heart-related deaths with androgen deprivation therapy three times higher in men with congestive heart failure or history of heart attacks

Ingrid Torjesen

Wednesday, 29 October 2014

Certain prostate cancer medications appear to increase the risk of dying from heart-related causes in men with congestive heart failure or prior heart attacks, according to a study* published in BJU International today.

Androgen deprivation therapy (ADT), which reduces levels of male hormones in the body to prevent them from stimulating cancer cells, is a mainstay of treatment for prostate cancer. However, ADT has been associated with heart problems, including increased risk of diabetes, coronary heart disease, heart attacks, and sudden cardiac death.

To investigate this potential link, US researchers analysed information on 5,077 men with prostate cancer who were treated between 1997 and 2006. Thirty percent of these men received ADT, while the others did not.

After a median follow-up of 4.8 years, no association was detected between ADT and heart-related deaths in men with no cardiac risk factors (1.08% at five years for ADT versus 1.27% at five years for no ADT) or in men with diabetes, hypertension, or high cholesterol (2.09% vs 1.97%).

However, ADT was associated with a 3.3-times increased risk of heart-related deaths, in men with congestive heart failure or prior heart attacks. In this subgroup, heart-related deaths occurred in 7.01% of men receiving ADT versus 2.01% of men not receiving the drug after five years. This suggests that administering the therapy to 20 men in this potentially vulnerable subgroup could result in one cardiac death.

Dr Paul Nguyen, of the Dana-Farber/Brigham and Women's Cancer Centre in Boston, said: "While androgen deprivation therapy can be a lifesaving drug for men with prostate cancer and significantly increase the cure rates when used with radiation for aggressive disease, this study also raises the possibility that a small subgroup of men who have significant heart disease could experience increased cardiac death on ADT.”

While he noted that because the study was retrospective and must be carefully weighed against larger controlled trials that have demonstrated the benefits of ADT, he said: "I would still say that for men with significant heart problems, we should try to avoid ADT when it is not necessary—such as for men with low-risk disease or men receiving ADT only to shrink the prostate prior to radiation. However, for men with high-risk disease, in whom the prostate-cancer benefits of ADT likely outweigh any potential cardiac harms, ADT should be given even if they have heart problems, but the patient should be followed closely by a cardiologist to ensure that he is being carefully watched and optimised from a cardiac perspective."


* David R. Ziehr, et al. Association of androgen-deprivation therapy with excess cardiac-specific mortality in men with prostate cancer. BJU International. Vol 114 Issue5. doi: 10.1111/bju.12905

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