A new study titled “Association of androgen deprivation therapy with excess cardiac-specific mortality in men with prostate cancer”, published in the BJU International journal, has showed that some drugs used to treat prostate cancer can increase the risk of dying from heart-related causes in men who have congestive heart failure or have had prior heart attacks.
Androgen deprivation therapy (ADT) is commonly used to treat prostate cancer, and its mechanisms of action consist on reducing the levels of male hormones in the patient’s organism to prevent them from stimulating cancer cell’s growth and development.
However, despite its success in treating some forms of prostate cancer, ADT has been linked to cardiovascular problems, such as coronary heart disease, heart attacks, and sudden cardiac death.
To understand if cardiac-specific mortality (CSM) was actually connected to ADT treatment, the team of researchers, led by Paul Nguyen, MD, of the Dana-Farber/Brigham and Women’s Cancer Center in Boston, along with David Ziehr of Harvard Medical School, analyzed 5,077 men with a median age 69.5 years, that had been diagnosed with prostate cancer and were treated with brachytherapy (a type of internal radiotherapy), with or without neoadjuvant ADT between the time period of 1997 until 2006.
Accounting for different factors such as age, year of brachytherapy, and ADT treatment propensity score, researchers evaluated the association between ADT and CSM in men with prostate cancer and no cardiovascular comorbidity, with coronary artery disease risk factors, congestive heart failure (CHF) or past myocardial infarction (MI).
The results showed that 30% of patients studied had received ADT treatment. After a median follow-up of 4.8 years, there was no significant association verified between ADT and heart-related deaths in men with no cardiac risk factors or in men who had diabetes, hypertension, or high cholesterol.
Nonetheless, there was a 3.3 times higher risk of heart-related deaths in men suffering from congestive heart failure or prior heart attacks who received ADT.
“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. 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 optimized from a cardiac perspective,” Dr. Nguyen explained in a Wiley press release.