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 institutions.

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 cause-and-effect relationship."

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 Cancer Institute.

Brigham and Women's Hospital is a 747-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare System, an integrated health care delivery network. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832 and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives, dedication to educating and training health care professionals, and strength in biomedical research. With $370 million in funding and more than 500 research scientists, BWH is an acclaimed leader in clinical, basic and epidemiological investigation including the landmark Nurses Health Study, Physicians Health Studies, and the Women's Health Initiative. For more information about BWH, please visit www.brighamandwomens.org.