Androgen deprivation therapy — one of the most common treatments for
prostate cancer — may increase the risk of death from heart disease in
patients over age 65, according to a new study by researchers at
Dana-Farber Cancer Institute, Brigham and Women's Hospital and other
The study results were based on data from CaPSURE, a national
registry of men with prostate cancer. Although the findings need to be
confirmed in clinical trials, the study authors state that oncologists
should weigh the benefits of androgen deprivation therapy, or ADT,
against the risk of heart problems in older prostate cancer patients.
The researchers presented their study at the Prostate Cancer
Symposium in Orlando, Fla., on Feb. 24. The symposium is sponsored by
the American Society of Clinical Oncology, the American Society for
Therapeutic Radiology and Oncology and the Society of Urologic Oncology.
Prostate cancer cells
The goal of ADT is to block the level of circulating androgens (male
hormones), which can fuel the growth of prostate cancers. "Androgen
deprivation therapy is associated with elevated body mass index,
increased body fat deposits and diabetes, all of which raise the risk of
death from heart diseased," explains the study's lead author, Henry
Tsai, MD, a resident physician at Dana-Farber, Brigham and Women's and
the Harvard Radiation Oncology Program. "Although our findings
demonstrated that older men receiving this treatment may be at increased
risk, even after taking into account other cardiovascular risk factors,
a prospective clinical trial would be needed to confirm a
Drawing on the CaPSURE database, Tsai and his colleagues compared the
number of cardiac-related deaths among 735 men with localized prostate
cancer who received ADT and among 2,901 men with the disease whose
treatment did not include ADT.
After factoring in other known risks for cardiovascular disease (such
as diabetes, hypertension, body mass index and smoking), researchers
found that the longer patients received ADT, the sooner they were likely
to die from heart disease. When the researchers analyzed the data by
patients' age, the link between ADT use and death from heart disease was
significant in patients over age 65, but not in those under 65. After
five years, 3 percent of older men who received androgen deprivation
therapy died of cardiac causes, compared with only 0.9 percent of men
who did not receive the therapy.
"These findings should help oncologists determine which older
patients are the best candidates for ADT," Tsai remarks. "If a patient
is at high risk of cardiovascular disease, it would be advisable for an
oncologist to discuss the pros and cons of ADT treatment with him before
proceeding on a course of treatment."
Co-authors of the study include Anthony D'Amico, MD, PhD, of
Dana-Farber and Brigham and Women's, Ming-Hui Chen, PhD, of the
University of Connecticut, and Natalia Sadetsky, MD, MPH, and Peter R.
Carroll, MD, both of the University of California, San Francisco.
The CaPSURE database is a research collaboration between TAP
Pharmaceutical Products, Inc., and the University California, San
Francisco, Department of Urology. The study was funded in part by the
CaPSURE Scholars Program in Prostate Cancer Outcomes Research.
Dana-Farber Cancer Institute (www.dana-farber.org)
is a principal teaching affiliate of the Harvard Medical School and is
among the leading cancer research and care centers in the United States.
It is a founding member of the Dana-Farber/Harvard Cancer Center
(DF/HCC), designated a comprehensive cancer center by the National
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